Entyvio vs Humira (Vedolizumab Vs Adalimumab)

Entyvio vs Humira (Vedolizumab Vs Adalimumab) is a head to head comparison of the two tumor necrosis factor inhibitors (TNF inhibitors) in the treatment of patients with inflammatory bowel diseases.

Entyvio is a humanized IgG1 monoclonal antibody that acts against α4β7 integrin which plays a main role in gastrointestinal inflammation. While Humira is a TNF inhibitor that is produced by recombinant DNA technology administered for the treatment of rheumatoid arthritis and other chronic inflammatory conditions.

These drugs will be compared on the basis of their pharmacokinetics and efficacies in inflammatory bowel diseases (Ulcerative colitis and Crohn’s disease).

Read: TNF Inhibitors: An Overview of Their Use in Immune-mediated Diseases

Generic Names:

Entyvio: Vedolizumab

Humira: Adalimumab

Entyvio vs Humira (Vedolizumab Vs Adalimumab): Indications

Entyvio vs Humira (Vedolizumab Vs Adalimumab): Pharmacokinetics

Entyvio vs Humira (Vedolizumab Vs Adalimumab): Mechanism of Action (MOA):

Entyvio (Vedolizumab):

• Vedolizumab specifically binds to α4β7 integrin which is present on the surface of lymphocytes (T&B). By this binding vedolizumab inhibits the adhesion of lymphocytes to MADCAM-1 (mucosal addressing cell adhesion molecule-1) and inhibits the entry of lymphocytes in the Gut wall and gut-associated lymphoid tissue (GALT). This prevents inflammation without disturbing systemic immune responses.

Humira (Adalimumab):

• Adalimumab binds to TNF-α and inhibits its interaction with its cell surface receptor. TNF is a natural cytokine that plays a major role in inflammatory conditions and natural immune responses. Increased levels of TNF are found in patients with rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis. Adalimumab also changes other biological responses induced by TNF including altered levels of adhesion molecules that play role in inflammation.

Entyvio vs Humira (Vedolizumab Vs Adalimumab) Efficacy in IBDs:

Entyvio vs Humira (Vedolizumab Vs Adalimumab) efficacy in Ulcerative colitis:

Humira (Adalimumab) in Ulcerative Colitis:

• Adalimumab is an approved treatment for inflammatory diseases including Ulcerative colitis. It is indicated for the prevention of disease progression and to induce clinical remission in patients who have had inadequate responses to other immunomodulators.
• The efficacy of adalimumab was examined in a study. In this study adalimumab, 160 mg was administered at week 0, then 80 mg and 40 mg were administered onward. In this study, adalimumab proved to be more effective than placebo and was able to induce clinical remission. It was concluded that overall adalimumab showed 10% better results than placebo. The risk-to-benefit ratio of adalimumab combined with other treatments and overall disease stage makes it a viable treatment option as compared to other corticosteroids.[Ref]
• There is limited data available on the comparative efficacy of TNF agents but one study that compared efficacy of adalimumab and infliximab in ulcerative colitis suggested that patients treated with infliximab had a lower need for corticosteroids and other drugs as compared to those who were on adalimumab therapy. It was also concluded that a higher percentage of patients observed clinical remission with infliximab therapy. Adalimumab might be a treatment option for patients who are irresponsive to other TNF agents. [Ref]
• Another study suggests that a higher dose of adalimumab 160/80 mg is required for a longer period of time to attain clinical remission. [Ref]
• In a comparative study of TNF agents (infliximab, certolizumab, and adalimumab) the most effective in the treatment of ulcerative colitis was infliximab. Adalimumab was comparable to certolizumab in efficacy and clinical remission.[Ref]

Entyvio (Vedolizumab) in Ulcerative Colitis:

• Vedolizumab is also an effective drug against ulcerative colitis. The long-term efficacy of vedolizumab was investigated in a study in which vedolizumab naïve, TNF antagonist-naïve, and TNF antagonist experienced patients were involved. 81% of patients were in remission after 52 weeks, 88% and 96% were in clinical remission after 104 and 152 weeks respectively.[Ref]
• Although TNF therapy is the most commonly used treatment in inflammatory conditions but its loss of response is up to 40%. And patients who lost response to one TNF agent might less likely respond to another TNF agent. In this study, previous populations who failed to respond to TNF inhibitors experienced clinical benefits with the use of vedolizumab. Another study conducted on the efficacy of vedolizumab in TNF naïve patients suggested that vedolizumab can be used as a first-line treatment in ulcerative colitis.[Ref]
• The safety of vedolizumab in patients with ulcerative colitis has been evaluated in various trials. Although there is limited data available on long-term safety, treatment with vedolizumab for up to 5 years is associated with an excellent safety profile. Existing data indicates a safety advantage of vedolizumab over TNF inhibitors[Ref]
• One study conducted on the comparative efficacy of adalimumab and vedolizumab suggested that at week 52 a higher percentage (31.2%) of patients achieved clinical remission with vedolizumab than with adalimumab (22.5&).[Ref]

• A higher percentage of patients achieved endoscopic improvement with vedolizumab as compared to adalimumab

Entyvio vs Humira (Vedolizumab Vs Adalimumab) efficacy in Crohn’s Disease:

Humira (Adalimumab) efficacy in Crohn’s disease:

• Adalimumab is effective in treatment of Crohn’s disease. One study designed to assess the clinical efficacy of adalimumab in CD suggests that adalimumab treatment is 64% successful in improving symptoms of Crohn’s disease.53% of patients in this study were surgery-free for approximately 4 years. This suggests that adalimumab therapy can reverse strictures.[Ref]
• In a retrospective, cohort study comparative efficacy and safety of TNF inhibitors in 3205 biologic naïve patients was assessed. The results showed that compared to adalimumab, infliximab-treated patients had a lower risk of hospitalization, abdominal surgery, and corticosteroid use.[Ref]

Entyvio (Vedolizumab) efficacy in Crohn’s disease:

• Vedolizumab therapy is more likely to be effective in patients with Crohn’s disease. Efficacy of vedolizumab assessed in one study showed that vedolizumab treatment had greater remission rates as compared to placebo but they were less likely to have a CDAI-100 response. Vedolizumab shows a greater response rate than TNF antagonists. Approximately 50% of patients experience treatment failure due to loss of response or side effects in TNF therapy.[Ref]
• Another study conducted to assess the comparative efficacy of vedolizumab and adalimumab suggested that vedolizumab therapy is safe and effective in inducing clinical remission in patients with CD. Vedolizumab showed better remission and mucosal healing rates as compared to adalimumab.[Ref]
• Vedolizumab is generally a safe treatment option as compared to TNF antagonists, clinical trials suggest that vedolizumab is more effective during early stages with greater rates of clinical remission. In some cases, the advanced stage of Crohn’s disease might still require TNF therapy.[Ref]

Conclusion:

In the review of above-mentioned studies and trials, it is concluded that vedolizumab is an excellent choice for the treatment of ulcerative colitis. It is also effective and safer than adalimumab. Adalimumab is inferior to other TNF-inhibitors (infliximab) in the treatment of Crohn’s disease and ulcerative colitis. Vedolizumab is a better treatment option for earlier stages of Crohn’s disease to achieve clinical remission.

Read: Entyvio vs Remicade (Vedolizumab vs Infliximab) in IBDs