THE APPROVAL OF VEDOLIZUMAB FOR THE MANAGEMENT OF INFLAMMATORY BOWEL DISEASES IN BRAZIL: the beginning of a new biological era

Abstract

The management of inflammatory bowel diseases (IBD), has evolved significantly over the last decades. From an era when only corticosteroids and aminosalycilates were used in the eighties, passing through the administration of immunomodulators in the nineties and culminating in the use of biological agents such as infliximab (IFX) and adalimumab (ADA) in the late nineties and the beginning of this century, it is clear that even with the development of new drugs, remission rates still need to be improved in the IBD management (4). The experience with medical therapy for both Crohn's disease (CD) and ulcerative colitis (UC) also increased, and to date, the spread of the use of biological agents with no doubt improved outcomes and made patients' quality of life better over the last years (6). In Brazil, IFX was approved in the year 2000 and ADA in 2007, and several publications demonstrated the implementation of the biological therapy in our country (5). Still, anti-TNF agents do not represent the holy grail in the management of these inflammatory conditions. Several patients even do not respond or do have an initial response and loose efficacy over time. It is clear that anti-TNF agents changed paradigms in the management of these patients. However, several cases still need to switch treatment due to secondary loss of response, development of anti-drug antibodies and low serum levels (1). In the first semester of 2015, vedoluzimab (VEDO), an humanized antibody that blocks integrin α4-β7, was approved for the management of CD