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Therapeutic drug monitoring has been used to optimise treatment with other biological agents; however, the clinical applicability of measuring vedolizumab trough concentrations is unclear. Initial registration trial data demonstrated a positive exposure\u2013efficacy relationship of vedolizumab in IBD. However, there is conflicting data in more recent studies, with no definitive benefit of vedolizumab dose-escalation and no consistent target vedolizumab trough concentration identified. Also, unlike with anti-tumour necrosis factor agents, the clinical benefit of immunomodulator co-therapy with vedolizumab is uncertain. Although initial research suggested no clinical advantage of combining vedolizumab with an immunomodulator, more recent studies have shown potential benefit. 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