Entyvio vs Remicade compares the two drugs that target the tumor necrosis factor pathway. Entyvio is the brand name of Vedolizumab and is indicated primarily for the treatment of Crohn’s disease and ulcerative colitis. Remicade is infliximab indicated for autoimmune rheumatic conditions.
Remicade is a chimeric monoclonal IgG1 antibody that inhibits TNF-α, which is the key proinflammatory cytokine in chronic inflammatory conditions. While Entyvio is a recombinant humanized monoclonal IgG1 antibody that inhibits α4β7 integrin which plays a key role in gastrointestinal inflammation.
This article will compare both these drugs on the basis of Pharmacokinetics, Mechanism of action, efficacy, and side effects.
Entyvio vs Remicade (Vedolizumab vs Infliximab): Uses
Pharmacokinetics of Entyvio vs Remicade (Vedolizumab vs Infliximab):
|Half-life elimination||336-332 hours||7.7-9.5 days|
|Clearance||0.180 to 0.266 ml/Hour/kg||11-15 mL/hour or 0.18-0.25 mL/minute|
|Absorption||Maximum absorption through IV dose||Maximum concentration within 24 hours|
Mechanism of action of Entyvio vs Remicade (Vedolizumab vs Infliximab):
Vedolizumab selectively inhibits integrin α4β7 which has a key role in gastrointestinal inflammation. By this inhibition it prevents the binding of lymphocytes to their natural ligand, MAdCAM-1 thereby preventing the entrance of lymphocytic cell in the gut-associated lymphoid tissue (GALT). Inhibiting this pathway prevents GI inflammation without impairing other immune responses.
Infliximab is a monoclonal antibody that binds to TNF-α with high affinity and disrupts the proinflammatory process. This binding prevents the interaction of TNF with its receptors. Blocked actions of TNF lead to the downregulation of proinflammatory cytokines.
This results in reduced migration of leukocytes and lymphocytes to the inflammation sites, Induction of apoptosis or TNF producing cells, and reduction of endothelial adhesion molecules. Infliximab inhibits the actions of TNF and thereby reduces inflammation.
Entyvio vs Remicade (Vedolizumab vs Infliximab) efficacy in different disease conditions
Remicade Use in Ulcerative colitis:
- Current data suggest that infliximab is an effective treatment for ulcerative colitis. Current treatments for ulcerative colitis include antibiotics, anti-inflammatory drugs, and immunomodulators.
- Infliximab plays its role in reducing inflammation by binding to inflammatory cells and inducing apoptosis and elimination of these cells. It also inhibits the attachment of TNF to its receptors. Anti-TNF-α agents have been approved by FDA for the treatment of UC.
- In one study four clinical trials were performed to assess the efficacy of infliximab in ulcerative colitis. The results suggested that infliximab therapy began to improve disease symptoms during 8th week of the trial. There was no significant difference between placebo and infliximab during the first 6 weeks. The response rate with infliximab at 8th week was significantly higher than placebo. Infliximab is associated with improved symptoms and overall improved health-related quality of life.[Ref]
- In another meta-analysis the comparative efficacy of all TNF inhibitors was assessed, the results concluded that all TNF inhibitors were superior to placebo in reducing inflammation mucosal healing, and overall disease symptoms. Infliximab was found to be the most effective among other TNF inhibitors and adalimumab had the least effect as compared to others.[Ref]
- Infliximab can also be used for the treatment of pediatric ulcerative colitis. Although further data is required for assessing the safety. A recent review consisting of 6000 pediatric patients did not report any serious malignancies by the use of infliximab.
Entyvio use in Ulcerative Colitis:
- Vedolizumab plays role in reducing gastrointestinal inflammation. It is effective for the treatment of ulcerative colitis. One study designed to assess the long-term safety and efficacy of vedolizumab in UC suggests that vedolizumab is effective in improving all disease symptoms with an 88% remission rate.
- It was also found to be effective in patients who were previously treated with TNF inhibitors and discontinued therapy due to lack of efficacy. It has also been found to be a good alternative first choice for TNF naïve patients. Vedolizumab maintenance therapy was associated with greater reductions in corticosteroid use than placebo. Increasing dosage frequency also resulted in increased efficacy.[Ref]
- In a multicenter, observational cohort study of UC patients, a comparison of TNF therapy and vedolizumab therapy was done. The study concluded that Vedolizumab-treated patients greatly achieved clinical remission, steroid-free clinical remission, and steroid-free deep clinical remission than those treated with TNF antagonists. There were no significant differences in serious side effects of vedolizumab therapy and there was a lesser incidence of adverse events in TNF naïve patients. [Ref]
- Another study in which Infliximab and vedolizumab were compared revealed that a higher proportion of patients responded to vedolizumab therapy as compared to infliximab. Although the clinical response rates were similar, the Infliximab group had a higher discontinuation rate.[Ref]
Read: TNF Inhibitors; An Overview of Their Use in Immune-mediated Diseases
Remicade Use in Crohn’s disease:
- Infliximab has been remarkably efficacious in treating clinically active Crohn’s disease but it is often thought to be too powerful and rapid that it could induce fibrosis in deeper layers of the gut wall and could be responsible for new stricture formation. This drug may not be used in preexisting stenoses.
- Recent observational studies however suggest that infliximab is anti-fibrogenic (rather than pro). Recent studies confirm that infliximab does not cause stenoses and reduces a substantial degree of inflammation in CD patients. It is also indicated the infliximab reduces disease recurrence after the surgery. [Ref]
- Clinical trials have shown infliximab to be efficacious, safe, and generally well tolerated. It is effective in treating patients with steroid-dependent CD and those with fistulizing CD. Although it is effective, it has a low response rate. The formation of antibodies also affects the efficacy and may be responsible for loss of response.[Ref]
- Infliximab is not approved to be used in children. Some studies conducted on its off-Label use suggest that it may be efficacious in treating pediatric Crohn’s disease but further data is still required to confirm these studies.[Ref]
Entyvio use in Crohn’s Disease:
- Vedolizumab, a gut‐selective α4β7 integrin antibody is effective in the treatment of Crohn’s disease. An open-label study conducted to assess the long-term efficacy of vedolizumab suggested that the safety profile of vedolizumab is favorable with no new safety concerns. Vedolizumab is well-tolerated and greatly improved health-related quality of life in CD patients.[Ref]
- Vedolizumab therapy is generally safer than TNF antagonists, but it is more efficacious during the early stages of the disease. This suggests that later disease stages might still be treated with TNF antagonists.[Ref]
Although both the drugs are effective, Entyvio is generally more effective in ulcerative colitis. In Crohn’s disease, Entyvio is safer than infliximab and also effective in early disease while infliximab is more effective in patients with longer disease duration however, it generally has a low response rate and a high discontinuation rate.