A decade of clinical data with vedolizumab: the past, present, and future

Inflammatory bowel disease (IBD) is a chronic inflammatory disorder of the gastrointestinal tract, typically classified as either ulcerative colitis (UC) or Crohn's disease (CD). The treatment approaches for both UC and CD have changed substantially over the last 10 years, going from step-up to top-down approaches and culminating in treat-to-target algorithms. In addition to the evolution of treatment strategies for IBD, disease endpoints have also changed from symptom-based outcomes to more objective measures, including endoscopy, with histology and transmural healing currently under investigation. In this narrative review, we describe recent advances in the treatment of patients with IBD, with a focus on vedolizumab, the first and only anti-lymphocyte trafficking agent approved as a gut-selective biologic for induction and maintenance therapy in IBD. Furthermore, with the approval of more biologic agents, there remains a need to determine the sequence in which biologics should be used, both individually and in combination. Substantial progress has been made in the last decade, and even though biomarkers and algorithmic trials have been largely disappointing, other avenues, such as clinical decision support tools, prognostic tools, and new approaches incorporating computational biology, have the potential to more effectively curate a tailored approach to IBD therapy in the coming years.