Entyvio, the brand name for the generic vedolizumab, is a monoclonal antibody that is either injected or infused into patients who suffer from severe forms of the inflammatory bowel diseases ulcerative colitis (UC) or Crohn’s disease and have not responded to other therapies. In this article, we will explore what Entyvio is, its potential side effects and limitations, and some holistic alternatives and lifestyle changes that may help relieve symptoms instead of, or in addition to, Entyvio. 

What Is Entyvio and What Does It Do? 

Entyvio (vedolizumab) is a drug administered via infusion to patients with moderate to severe ulcerative colitis (UC) and Crohn’s disease who have not responded to other methods of treatment, such as corticosteroids and tumor necrosis factor antagonists (anti-TNF drugs). If your Crohn's or UC has relapsed, or you're intolerant to other treatments, your health care provider may suggest that you consider Entyvio. 

Entyvio is a biologic, a drug made from biological materials, such as proteins or DNA. Biologics target specific parts of the immune system in order to fight disease. How vedolizumab works is not entirely understood, but it is thought to block T-cells (white blood cells that help the immune system battle germs) and components of the innate, or nonspecific, immune response from attacking the intestines and causing inflammation. (Source, Source) 

In addition to being a biologic, vedolizumab also belongs to a class of medicines known as integrin receptor antagonists, also called anti-integrin therapy. These drugs block the action of certain cells in the body that specifically cause inflammation. Entyvio is not associated with the occurrence of dangerous side effects, so it's considered to be safer for older patients, as well as for patients with multiple sclerosis. (Source)

How Is Entyvio Administered? 

Entyvio is administered intravenously (IV) or as an injection (although so far the injectable version hasn't been approved in the United States). The infusion takes about 30 minutes, although you might spend a couple of hours at the clinic, since a health care provider will monitor you both throughout the process and afterward to check for side effects and adverse reactions. (Source, Source) 

How Long Do You Stay on Entyvio?

When you first start Entyvio, you’ll begin with 3 infusions. Your first dose will be considered week 0, your second at week 2, and then the third at week 6. After those initial doses, you'll be given maintenance doses every 8 weeks. 

Some patients may feel a benefit within 2 to 3 weeks of starting therapy, but it typically takes 6 to 8 weeks in ulcerative colitis and 10 to 14 weeks in Crohn’s disease to achieve a significant benefit. If you’re not showing improvement in your symptoms by week 14, your health care provider may choose another course of treatment. 

Once you've been on Entyvio for a year, you'll receive 6 doses every year. (Source) 

Contraindications and Cautions for Entyvio Use

You should alert your health care provider before starting Entyvio if you:  

• are pregnant or planning to become pregnant: It's not yet known if Entyvio is safe to take during pregnancy. 
• are breastfeeding or planning to breastfeed, since Entyvio can pass into breast milk
• have an allergy to Entyvio or anything in it 
• have liver problems 
• have tuberculosis or have been in close contact with someone who does 
• have signs of an infection, such as fever, chills, muscle aches, cough, shortness of breath, runny nose, sore throat, red or painful skin or sores, tiredness, or pain during urination
• have recently gotten a vaccine or are scheduled to get one
• are taking any other medications, especially a tumor necrosis factor (TNF) blocker, a corticosteroid, or any medication that suppresses your immune system
• are taking vitamins or supplements, such as probiotics

(Source, Source)

Side Effects of Entyvio 

Common side effects of Entyvio may include: 

• injection site reactions such as redness, itching, bruising, pain, and swelling 
• infections such as cold, flu, sinusitis, and bronchitis 
• nausea 
• headaches 
• pain in the throat, arms, legs, and joints 

• signs of infection such as chills and fever
• fatigue

(Source) 

More serious side effects of vedolizumab are rare, but possible. They include: 

• allergic reactions related to the infusion: A health care provider will monitor you during the infusion and for some time afterward, watching for signs of a reaction, such as swelling of the lips, tongue, throat, or face, itching, a rash, shortness of breath, trouble breathing, wheezing, dizziness, feeling hot, or heart palpitations.
• serious infections: Reported vedolizumab-related infections include tuberculosis, salmonella sepsis, Listeria meningitis, giardiasis, and cytomegaloviral colitis. Your health care provider should test you for tuberculosis before you begin taking Entyvio.
• progressive multifocal leukoencephalopathy (PML): The risk of developing this rare brain infection while taking vedolizumab is small.
• pancreatitis 
• reactivation of hepatitis B
• liver damage 

(Source, Source, Source,Source)

New Symptoms Requiring Medical Attention

If you experience any of the following while on vedolizumab, contact your health care provider: 

• confusion
• problems thinking
• loss of balance
• change in the way you walk or talk
• decreased strength or weakness on one side of the body 
• blurred vision or loss of vision
• fatigue 
• loss of appetite 
• pain in the abdomen on your right side 
• jaundice, or yellowing of the skin and eyes 
• dark urine

(Source)

Limitations of Entyvio 

While Entyvio has shown efficacy in inducing and maintaining remission in patients with inflammatory bowel disease (IBD), it also has its limitations. For example, because vedolizumab does not suppress immune response, it was thought it would not pose the same risk of serious infections that immunosuppressant drugs do. However, a recent study suggests this may not be the case.

A large review of IBD patients in the United States and France found that overall the risk of serious infections did not differ between patients on vedolizumab and those being treated with immunosuppressants known as TNF inhibitors. However, the study found that vedolizumab was less likely than TNF inhibitors to cause serious infections in those with UC. (Source) 

Furthermore, vedolizumab may not be effective for all patients with IBD, as some patients may develop antibodies against the medication, reducing its effectiveness. Overall, while vedolizumab has shown promise in treating Crohn’s and UC, it is not without limitations and careful consideration should be given to its use in individual patients.

Are There Non-Pharmacologic Alternatives to Entyvio? 

While health care providers may prescribe short-term or long-term medications and/or recommend surgery for ulcerative colitis or Crohn’s, there are lifestyle modifications and non-pharmacological therapies that may help relieve flares as well. Here are 6 ways to improve your health with IBD, whether or not you are taking medication. (Source) 

1. Bowel Rest 

If your Crohn's symptoms are severe, bowel rest may be recommended to reduce inflammation and allow your intestines to heal. During bowel rest, you'll be given a nutrient-containing liquid, called an enteral nutrition formula, in place of solid food. Some enteral nutrition formulas can be taken by mouth, while others are passed through a tube directly into your stomach or lower intestines. In some cases formula may be delivered parenterally, or via an IV. Depending on the type of formula used, bowel rest may be done in the hospital or at home. (Source)  

2. Improve Gut Health

Ulcerative colitis and Crohn’s disease have been linked to dysbiosis, or disruption of the balance of microbes living in the gut. For example, one study conducted by Stanford University School of Medicine revealed that patients with IBD were deficient in certain beneficial bacteria, specifically Ruminococcaceae, that play significant roles in maintaining gut health. (Source, Source)

Gut health can be improved by: 

• drinking enough water: How much water you need depends on your weight, how much you exercise and the environment in which you do it, as well as if you're pregnant or breastfeeding, and how much caffeine you regularly consume. To get a more accurate idea of how much water you need, use a calculator like this one.   (Source) 
• managing stress: Consider trying yoga, meditation, and/or diaphragmatic breathing. (Source)
• adding gut-friendly supplements, such as probiotics and omega-3s (Source) 
• utilizing practices for mindful eating, such as chewing well (Source) 
• getting regular exercise (Source)
• getting enough sleep (Source) 

3. Avoid Trigger Foods

What you eat can heavily influence how you feel. Which foods trigger flares varies from person to person, so keeping a personal food diary can help you identify your triggers and see if avoiding them provides relief. 

Here are some food groups that may be associated with flares: 

• foods that are high in fiber, which makes your gut work extra hard: These foods include whole grains, beans, fruits, and raw vegetables such as Brussels sprouts, broccoli, cauliflower, and cabbage. 
• highly acidic beverages such as coffee or alcohol that may irritate the GI tract: Highly caffeinated beverages can irritate the intestines, contributing to malnutrition caused by poor absorption of nutrients in patients with Crohn’s. 
• Similarly, spicy foods can also irritate the digestive system. 
• refined sugar: Research suggests high-sugar diets contribute to dysbiosis and inflammation. (Source)
• Nuts and seeds can have sharp edges when eaten whole and may irritate the lining of the GI tract. Grinding nuts and seeds, as with peanut or almond butter or tahini, can make them less irritating. (Source)
• dietary fats and oils in greasy foods such as french fries or fried chicken: The oils used for processed and prepared foods may further increase inflammation. (Source) 
• foods that contain gluten: A component of gluten called gliadin may cause inflammation, especially if you have a gluten sensitivity. (Source)
• For those with a dairy allergy, consuming dairy may also cause inflammation. (Source)

4. Create a Healthy Diet 

There are many foods that can be incorporated into your diet that will improve how you feel, provide good gut health, and reduce inflammation in your body. 

• Fermented foods such as sauerkraut, kimchi, and miso have probiotics that can help maintain a diverse gut microbiome, allowing good gut bacteria to flourish and aid in optimal digestion. 
• Nutrient-dense foods such as bone broth that contain a lot of minerals, protein, amino acids, and collagen can be anti-inflammatory and fill in nutritional gaps and mineral deficiencies. 
• Foods that are high in omega-3 fatty acids also reduce inflammation. Think salmon, mackerel, and sardines, as well as flaxseed oil, walnuts, and olives. (Source)
• A variety of fruits and vegetables can also ensure nutritional needs are met. However, cooked foods are easier to digest than raw, and fruit and vegetable skins and seeds  should be removed prior to consumption, as they can be hard to digest. It’s important to take a personalized approach in what you consume, ensuring that you avoid fruits and vegetables that trigger flares for you. (Source, Source) 
• Protein-rich foods include meats such as turkey, chicken, fish, and grass fed beef, as well as non-meat sources, such as legumes, soy, and quinoa. However, a 2022 study published in the Journal of Crohn’s and Colitis confirmed earlier findings that consumption of red meat is associated with greater risk of developing UC, although it doesn’t seem to increase the risk of Crohn’s. Fish, eggs, and dairy products were not found to increase incidence of either form of IBD. (Source, Source)

5. Practice Proper Sleep Hygiene 

In those with IBD, sleep disturbances have been associated with inflammation and an increased risk of relapse. Therefore, optimizing sleep can help ensure your immune system is properly regulated. Here are some tips for better sleep hygiene.

• View sunlight within 30 to 60 minutes of waking to help synchronize your circadian rhythm. 
• Eat your last meal, refrain from exercise, and wear blue light blocking glasses 3 hours before bed. 
• Avoid caffeine 8 to 10 hours before bedtime. 
• Try to maintain a consistent schedule for going to bed and waking up. 
• Keep your bedroom cool and dark while sleeping. 

(Source, Source, Source)

6. Stress Management 

Stress can exacerbate symptoms and trigger flare-ups. While some level of stress is important for a proper “fight or flight” response and dealing with everyday challenges, prolonged and chronic stress can affect your health and your immune response. It’s important to recognize when you are in an “overstressed” state, and the ways you might achieve a state of balance. (Source)

• Prioritize personalized self-care activities that promote relaxation and well-being, such as exercise, deep breathing exercises, or creative activities such as drawing and painting.
• Common stress-reducing techniques include yoga and mindfulness meditation. 
• Spend time with family, friends, or support groups to share experiences, concerns, and emotions. 
• Proper time management and staying organized can help break overwhelming tasks into manageable and realistic goals.
• Journaling and practicing gratitude allow you to create a ritual to remind yourself of how much joy and appreciation can be found in your life. (Source)      

The Bottom Line 

Entyvio (vedolizumab) is a monoclonal antibody that is injected or administered intravenously to treat severe forms of inflammatory bowel disease. Vedolizumab may not be safe and effective for everyone with IBD due to its numerous possible side effects, and because some people can develop antibodies against the drug. 

Entyvio is not the only option for treating symptoms of ulcerative colitis or Crohn’s, and lifestyle modifications involving proper nutrition, sleep, exercise, and stress management can help support your health whether or not you take Entyvio. If you’ve been prescribed Entyvio or are considering taking it, WellTheory's Care Team can support your efforts to alleviate your IBD symptoms and increase your well-being and quality of life.