A 34-year-old woman with moderately active luminal Crohn's disease has failed adequate trials of conventional immunosuppressants (azathioprine and methotrexate). She is now considered for biologic therapy. Which biologic is specifically approved for Crohn's disease with a gut-selective mechanism (anti-integrin)?
- A Vedolizumab (anti-α4β7 integrin) ✓
- B Infliximab (anti-TNF)
- C Ustekinumab (anti-IL-12/23)
- D Tofacitinib (JAK inhibitor)
Explanation
Vedolizumab is a gut-selective anti-integrin monoclonal antibody that specifically blocks the α4β7 integrin on lymphocytes, preventing their binding to the MAdCAM-1 addressin on gut endothelium and thus selectively reducing gut inflammation without systemic immunosuppression. It is approved for moderate-to-severe luminal Crohn's disease (GEMINI 2 and 3 trials). Infliximab and adalimumab (anti-TNF) are effective but not gut-selective. Ustekinumab (UNIFI, CERTIFI) targets IL-12/23 and is also approved for Crohn's, but is not gut-selective. Tofacitinib is a pan-JAK inhibitor approved for UC, not Crohn's.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.