Anyone could explain why a treatment like entyvio could not work for some people?
As it blocks the movement of the gut-directed white blood cells into the GI tract, how could the bowel still get inflammed with this treatment?
Unfortunately no treatment works for everyone. For some people, the inflammation is just too severe for the medications to change things enough to avoid surgery or to gain complete remission. Vedo only seems to work on a very specific part of the gut, so for people with Crohns disease, it may be that the inflammation is too widespread for the Vedo to work.
I have been on vedo for almost a year now, and I still get symptoms a fair amount of the time, but I am better than I was before I started it, so it is having some impact. The issue is that my Crohn's is located on the very edge of where Vedo is targetted at.
It's also known to be a slower acting drug than many of the other treatments. I have been told that its not unheard of for people to need a year or more on it before they reach remission, and for some its just keeps them steady rather than inducing remission on its own.
Vedo works by trying to stop new inflammation forming through changing the way that white blood cells work. It takes a long time for the "old" white blood cells to die, and its only once the old cells are all dead and the new ones reach the gut that it really starts to work. For some people, this period is too long as their condition is too unstable and they need emergency treatment. The deeper into the lining the inflammation goes, the longer it takes for the body to repair itself.
Another factor is that for some people the infusions just don't last for the gap between them. If the infusion wares off between doses, it means that it doesn't suppress the cells in the desired way, so inflammation continues to occur. Infusions can be brought closer together in some cases but this isn't always appropriate due to people developing anti-bodies or suffering side effects.
As well as all this, sometimes the side effects are just too much to cope with. Some people suffer badly with headaches after infusions or have problems with their liver or kidneys and this makes the medication unsuitable.
Despite all of this, I still absolutely think its worth a try if people are offered. It generally has less serious side effects than the other biologics, and my doctors all tell me that it has a very good long term safety profile. I have heard stories where it has really transformed peoples lives and for me it has at least stopped me from detriorating and given me some quality of life. Unfortunately there are no garuntees with this illness and people never know what treatments will work for them, but there are more medications coming out all the time and I know from my IBD nurse that they are trying to create a version of Vedo that will work on the whole gut which would be a massive step forward.