In Crohn’s disease, overactivity in your immune system causes long-lasting inflammation in your gastrointestinal (GI) tract. That leads to unpleasant symptoms and dangerous complications. While there is no cure, treatment can improve your symptoms and allow the damage to the lining of your intestines to heal.
One treatment your doctor may recommend for moderate to severe Crohn’s disease is a medication called an integrin receptor antagonist.
What Are Integrin Receptor Antagonists for Crohn’s Disease?
Integrin receptor antagonists are a type of biologic drug. That’s a lab-made version of a protein in your immune system called an antibody. They’re made using living cells and engineered to block certain processes that lead to inflammation.
How Do Integrin Receptor Antagonists Work?
Crohn’s damages your GI tract through a cycle of inflammation. Immune cells overreact and attack healthy tissues as if they were fighting off a germ. That signals even more immune cells to flood the area, and the damage continues.
Immune cells called T cells move out of your bloodstream and into your digestive tract by attaching themselves to cells lining the walls of your intestines. That’s done through anchoring proteins on the T cells called integrins. Integrin receptor antagonists block these anchors so the T cells can’t stick, helping to break the inflammation cycle.
Which Integrin Receptor Antagonists Are Used to Treat Crohn’s?
The integrin receptor antagonists used to treat moderate to severe Crohn’s disease are:
When Are Integrin Receptor Antagonists Used to Treat Crohn’s?
Doctors can prescribe integrin receptor antagonists to treat Crohn’s disease in several situations:
How Do You Take Integrin Receptor Antagonists?
Integrin receptor antagonists are liquid medications that you take either as a shot under your skin or as an infusion delivered through a needle placed into a vein in your arm (IV). You get the infusions at a medical center or special clinic. Vedolizumab can also be given at home by a visiting care worker if your insurance approves. You give yourself the shots at home after your doctor shows you how.
Natalizumab is an IV infusion you get every four weeks for as long as it helps you. Each infusion takes about an hour.
With vedolizumab, you start treatment with a series of 30-minute IV infusions in what’s called the induction phase. Then, you move to the maintenance phase, during which you either continue with infusions every eight weeks or switch to shots every two weeks.
How Effective Are Integrin Receptor Antagonists?
Integrin receptor antagonists can help you get into clinical remission — meaning few to no symptoms — and keep Crohn’s symptoms from coming back. Here are some results from clinical trials:
Are Integrin Receptor Antagonists Safe?
Natalizumab — both the original and biosimilar versions — comes with a boxed warning about the possibility of a brain infection called progressive multifocal leukoencephalopathy (PML). This is extremely rare but can cause serious disability and even death.
While vedolizumab hasn’t been shown to increase your risk for PML — and it doesn’t have a boxed warning — that’s still considered a possibility, especially if you already have a weakened immune system.
Integrin receptor antagonists can sometimes cause serious allergic reactions and liver damage. They can also make you more likely to get an infection.
In addition, natalizumab can lower your levels of platelets (cells that help your blood clot), which can lead to bleeding and bruising. And both the original and biosimilar versions of natalizumab have a warning for people who are or might become pregnant. This drug may cause low levels of platelets and red blood cells in a fetus.
What Are the Common Side Effects of Integrin Receptor Antagonists?
People taking integrin receptor antagonists can also have milder side effects. The most common include:
How Much Do Integrin Receptor Antagonists Cost?
Biologic drugs — including integrin receptor antagonists — are complicated and expensive to make. The medications approved to treat moderate to severe Crohn’s disease cost about $5,000 for each dose, but prices can vary a lot. That’s the manufacturer’s list price, before any discounts or insurance benefits. A biosimilar version of natalizumab is also available.
It’s likely that treatment with an integrin receptor antagonist will be covered by your insurance or Medicare plan. But your doctor will probably need to get approval before they prescribe it. What you’ll pay depends on your benefits.
If you need help paying for your medication, drug companies often have programs that can lower your insurance co-pay or get you the medication for free if you qualify. You can learn more by following these links:
Clinical Trials of Integrin Receptor Antagonists
Biologic drugs have changed the outlook for moderate to severe Crohn’s disease, and researchers are both studying the best ways to use them and working to develop new ones.
With integrin receptor antagonists, studies are comparing vedolizumab to other biologics to see whether it’s a better first choice and to see how well it works in combination with other biologics or other types of medication.
Clinical trials are an important step in the research process. You can take part in a scientific study to help doctors learn more about treating Crohn’s, and you might get access to cutting-edge new medications.
If you’re interested, check with your doctor. They can tell you if there’s a type of treatment that might be helpful, and whether a clinical trial would be safe for you. They may also know about studies taking place in your area. You can also check with medical centers or universities or search a government-run database of studies at ClinicalTrials.gov.
Are Integrin Receptor Antagonists Right for Me?
Biologic drugs are the go-to medication for treating moderate to severe Crohn’s disease, but each option has different potential benefits and risks. Your doctor will recommend a treatment plan, but you should work together to decide what’s best for you. Here are four things to discuss.