1. Agree completely
2. Agree with minor reservations
3. Agree with major reservations
4. Reject with reservations
5. Reject completely

Statement Rationale and Definition

For over a decade, biologic therapy in moderately to severely active ulcerative colitis (UC) and Crohn’s disease (CD) has targeted tumor necrosis factor-α (TNF).^1,2 The first TNF monoclonal antibody (anti-TNF) to become available was the chimeric molecule, infliximab (IFX), followed by the human anti-TNF molecules, adalimumab (ADA), golimumab, and certolizumab pegol (CTZ).³ Worldwide, IFX and ADA are approved for the treatment of UC and CD; CTZ is approved only for treatment of CD, and golimumab is approved only for UC.^2,4,5 A considerable number of UC cases failing conventional therapies with 5-aminosalicyclic acid, corticosteroids, and thiopurine antimetabolites may also fail anti-TNF treatment.⁶ Furthermore, since 30% to 50% of patients with moderately to severely active UC fail to respond to anti-TNF induction therapy, there is a substantial need for a target other than TNF, and an alternative biologic therapy that may be used as a first-line treatment in moderately to severely active UC has the potential to address this gap in treatment options.⁷ Vedolizumab, which targets the α₄β₇ integrin, is the first non-anti-TNF biologic therapy approved for patients with UC.^3,8 The α₄β₇ integrin is expressed on immune cells that bind to gut endothelial cells via mucosal vascular addressin cell adhesion molecule 1 (MAdCAM-1).⁸ This statement explores vedolizumab as a viable option for first-line biologic therapy in moderately to severely active UC for induction and maintenance of remission.