Vedolizumab
Other immunomodulating biologics
Other immunomodulating biologics
A gut-selective antibody against α4β7 integrin that keeps inflammatory lymphocytes out of the bowel wall in Crohn's disease and ulcerative colitis.
Quick facts
- Group
- Other immunomodulating biologics
- Target
- α4β7 integrin on gut-homing lymphocytes
- Used for
- Moderate to severe Crohn's disease
- Key effects
- Headache · Nausea · Joint or back pain
- Monitor
- Tuberculosis history · Liver symptoms · New confusion
- ATC
- L04AG05
No doses: the clinician sets them by the current guideline.
Mechanism of action
The figure shows the human α4β7 integrin headpiece bound to the Fab of Act-1, a mouse antibody that also blocks α4β7; vedolizumab itself is not in this crystal.
Vedolizumab is a humanised IgG1 antibody that binds the α4β7 integrin on lymphocytes. It blocks their attachment to MAdCAM-1, an adhesion molecule on the blood vessels of the intestinal mucosa, so fewer lymphocytes enter the inflamed gut. Unlike natalizumab, it does not block α4β1 binding to VCAM-1, which T cells use to enter the brain.
- Antibody binds α4β7 integrin on lymphocytes
- Lymphocytes cannot attach to gut MAdCAM-1
- Fewer lymphocytes enter the bowel wall
- Intestinal inflammation settles
Indications
- Moderate to severe Crohn's disease Crohn disease →
- Moderate to severe ulcerative colitis Ulcerative colitis →
Adverse effects
Common
- Headache
- Nausea
- Joint or back pain, pain in the limbs
- Sore throat and cold symptoms, tiredness
Contraindications
- Hypersensitivity to vedolizumab
- Active serious infection
Key interactions
- TNF inhibitors (infliximab, adalimumab)
- May add to the adverse effects of vedolizumab; not combined routinely.
- Vaccines, especially live vaccines
- Brought up to date before starting; during treatment only with the team's agreement.
What is monitored
- Allergic reactions during the infusion and for several hours after
- Tuberculosis history and exposure before starting
- Liver symptoms (dark urine, yellow skin or eyes)
- New confusion, weakness on one side, or speech or vision changes (PML)
- Response; treatment is reviewed if there is no benefit by week 14
Administration and safety
- The intravenous infusion is given by a doctor or nurse.
- The subcutaneous form can be self-injected at home after teaching.
- Vaccines are brought up to date before the first dose.
Pregnancy and breastfeeding
Human data are limited; pregnancy and breastfeeding plans are discussed with the treating team.
Nursing care
- Watch for rash, itching, swelling or breathing difficulty during the infusion and for several hours after.
- Before starting, confirm tuberculosis history and screening.
- Teach to report fever, cough, painful urination or red, painful skin.
- Teach to report new confusion, memory problems, one-sided weakness or vision changes at once.
Pharmacokinetics
- Absorption
- Intravenous infusion; after the first infusions it may be switched to subcutaneous injection
- Metabolism
- Broken down like other antibodies
Test yourself
Think of the answer, then tap the question to see it.
Which integrin does vedolizumab block?
α4β7 integrin on gut-homing lymphocytes.
Why is PML much rarer with vedolizumab than with natalizumab?
Vedolizumab blocks only α4β7–MAdCAM-1 in the gut; natalizumab also blocks α4β1–VCAM-1, which T cells need to enter the brain.
Which two diseases is vedolizumab used for?
Crohn's disease and ulcerative colitis.
Connections
← Back to the class: Other immunomodulating biologics
Educational content on how drugs work; not a prescribing guide and no substitute for a health professional's advice. No doses are given.
Sources: Vedolizumab Injection: MedlinePlus Drug Information (MedlinePlus (U.S. National Library of Medicine), 2026); RCSB PDB - 3V4P: crystal structure of a4b7 headpiece complexed with Fab ACT-1 (RCSB Protein Data Bank, 2012); ATCDDD - ATC/DDD Index (WHO Collaborating Centre for Drug Statistics Methodology, 2026).
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Representative model, for educational purposes only.