If you have Crohn's disease, you've probably heard of biologic therapies or medications. You might have even tried them. Whether or not this is a new treatment for you, you may have questions about these medications.
You can find the answers to some of them here.
What Are Biologics and How Do They Work?
Biologics are medicines developed in a lab. Unlike more common medications, biologics are created using living organisms, including animal cells and microorganisms like yeast and bacteria.
Biologic medications used to treat Crohn's disease work in the immune system to prevent inflammation.
The FDA approved the use of biologics as a treatment for Crohn's disease in 1998. Since then, biologics have helped improve the quality of life and health of hundreds of thousands of people with the condition.
According to recent studies, biologics not only improve symptoms and quality of life but also help heal the intestinal mucosa and certain types of fistulas (tunnels that form inside the body).
What Types of Biologics Are Used for Crohn's Disease?
The first biologic medication used to treat people with Crohn's disease was infliximab, which is still in use. But there are many other options besides this medication.
Your doctor might also prescribe a biosimilar treatment. These are designed to work the same way as approved biologic therapies. Their main active ingredient is the same, they work similarly to biologics, and they have the same dosage. Biosimilars might also cost less than biologics.
These are the biologic and biosimilar treatments available for Crohn's disease:
Tumor necrosis factor inhibitors. These medications neutralize a protein in the immune system known as tumor necrosis factor. This protein causes inflammation in the intestine and other organs and tissues.
- Adalimumab (Humira)
- Adalimumab-adbm (Cyltezo), a biosimilar to Humira
- Adalimumab-atto (Amjevita), another biosimilar to Humira
- Certolizumab pegol (Cimzia)
- Infliximab (Remicade)
- Infliximab-abda (Renflexis), a biosimilar to Remicade
- Infliximab-axxq (Avsola), a biosimilar to Remicade
- Infliximab-dyyb (Inflectra), a biosimilar to Remicade
Integrin receptor antagonists. These medications block a protein in immune cells that causes inflammation.
- Natalizumab (Tysabri)
- Vedolizumab (Entyvio). This drug is a monoclonal antibody that works by preventing certain immune system molecules from binding to other cells in the intestinal lining.
IL-23 antagonists. These medications are monoclonal antibodies that block a molecule known as interleukin-23. These treatments were recently approved for use in people with Crohn's disease.
- Guselkumab (Tremfya)
- Mirikizumab (Omvoh)
- Risankizumab (Skyrizi)
Ustekinumab (Stelara). This treatment blocks a protein called interleukin, which causes inflammation in the body.
Your treatment for Crohn's disease may include biologic medications and other types of medicines, such as anti-inflammatories, immunosuppressants, antidiarrheals, pain relievers, Janus kinase inhibitors, and antibiotics.
Your specific treatment will depend on the severity of your Crohn's disease and how much of your digestive system is affected.
How Are Biologics Given?
They can be given in two ways: as an infusion into the vein (IV) and as a shot.
Biologic medications are not taken orally because they contain large molecules that the digestive system can break down as they pass through it.
What Are the Most Common Side Effects?
Just like any medication, biologic treatments can cause side effects. Some of the most common ones include:
- Headache
- Fatigue
- Fever
- Chills
- Hives
- Rash
Some people might have an allergic reaction to the treatment.
Side effects vary depending on the treatment. To learn more about the specific side effects of the medication prescribed to you, talk to your doctor.
Are There Other Side Effects or Risks?
Biologic medications can affect the immune system, and this might make it harder for your body to fight some infections, including viral, bacterial, and fungal infections. To protect yourself, follow these tips:
- Before starting treatment, talk to your doctor about how you can prevent infections.
- Make sure you are up to date with all the vaccines your doctor recommends, including the flu shot.
- Contact your doctor immediately if you notice any symptoms of infection, such as a fever.
Rare side effects of biologic treatments include:
- Increased risk of developing lymphoma (a type of blood cancer)
- Liver problems
- Joint pain
- Lupus-like reactions
- Skin reactions, including risk of developing some skin cancers
Always remember that your doctor has prescribed this treatment because they believe the benefits outweigh the risks. If you have concerns about the risks or side effects of your medication, you should talk to your care team. Never stop using a medication without first talking to your doctor.
Why Did My Doctor Choose a Biologic Treatment?
Gastroenterologists (doctors who specialize in Crohn's disease) consider several things before deciding on the best treatment. When you visit the doctor, they will use the results of the tests they ordered, which could include blood tests, stool tests, and an endoscopy, to determine:
- The parts of the digestive tract affected by the condition
- The severity of the inflammation
- The characteristics of the disease (phenotype), including if it's inflammatory, if it affects the area around the anus, and more
Before prescribing any treatment, your doctor will also consider the following:
- Your personal characteristics, including age
- If you have any other condition
- If you have tried other treatments before and how they worked for you
- If you have developed antibodies to any treatment
- Your preferences
Your goals and preferences are also important when choosing the best treatment for your Crohn's disease. Decisions about treatments should always involve you, prioritizing what is important to you.
In the case of Crohn's disease, biologic treatments can help ease symptoms. But their benefits go beyond that, and they have been shown to have a lasting effect.
Some studies suggest that starting biologic treatment soon after diagnosis can help prevent Crohn's disease from progressing and lower the risk of more severe complications.
Why Was I Prescribed Another Medication Along With Biologics?
There are several reasons why your doctor may have prescribed more than one medication for your Crohn's disease.
It's common for Crohn's disease treatment to include more than one medication. Some help control symptoms. Others prevent new flare-ups.
Although biologic treatments have very positive results in many people, not everyone reaches their treatment goals with these therapies. Studies have shown that combining biologic treatments with other conventional medications can make treatment work better.
A study published in the National Library of Medicine (NLM) found that when the medications infliximab and adalimumab are combined with a conventional immunomodulator, treatment results improve. This combination also helps more people see good results than biologic or biosimilar medications alone.
Remember that what works for some doesn't work for everyone. Your care team will work with you to find the best treatment for your specific case.
Questions to Ask Before Starting a Biologic
It's important that you feel good about your treatment. This is why it's essential to talk openly and honestly with your care team. Here are some questions you can ask your doctor before starting a new treatment:
- What parts of my digestive system are affected?
- What medications will I be using and how do they work in my body?
- How will we know if we need to adjust my treatment?
- How long will it take for the medication to work?
- What are the possible side effects of the treatment and what should I do if I notice them?
- What serious side effects require immediate medical attention?
- What should I do if my symptoms return?
- How can I tell if I need to change my treatment?
- Should I change my diet or take supplements?
- Do I need to make other lifestyle changes?
- When should I schedule my follow-up appointment?
Show Sources
Photo Credit: iStock/Getty Images
SOURCES:
FDA: “Biosimilar and Interchangeable Biologics: More Treatment Choices.”
American Gastroenterological Association: “Biosimilars.”
Crohn’s and Colitis Foundation: “Biosimilars: What You Should Know,” “Fact Sheet: News from the IBD Help Center, Biologics,” “Managing Flares and IBD Symptoms,” “Medication Options for Crohn’s Disease.”
National Institutes of Health: “Biologics: how far can they go in Crohn’s disease?” “Biologic therapies for Crohn’s disease: optimising the old and maximising the new,” “Oral delivery of biologics using drug-device combinations,” “The Role of Early Biologic Therapy in Inflammatory Bowel Disease.”
Mayo Clinic: “Crohn's disease.”
