Many medicines can successfully treat ulcerative colitis (UC). These include biologic therapies or medications. If you've heard about these treatments or if your doctor prescribed one, you might have some questions.
You can find the answers to some of the most common ones here.
What Are Biologics and How Do They Work?
Biologic medications are therapies made in a lab using living organisms, including animal cells and microorganisms, like yeast and bacteria.
They treat Crohn's disease and UC, which are both inflammatory bowel diseases (IBDs). They also treat other chronic conditions, like cancer and arthritis.
Biologic treatments work in the body by blocking immune system chemicals that trigger inflammation.
For IBDs, the main goals of these treatments are to ease symptoms, achieve remission (when inflammation is under control or has stopped), and then keep the condition in remission.
There are also biosimilar treatments for UC. These are practically the same as approved biologics. Their main active ingredient is the same, they work the same way in the body as biologic therapies, and they have the same dosage. Biosimilars might also cost less than biologic treatments.
What Types of Biologics Are Used for UC?
Tumor necrosis factor inhibitors (anti-TNFs). These medications control intestinal inflammation by blocking an immune system protein known as tumor necrosis factor.
They are usually prescribed to people who have tried other medications without getting the desired results or who have had uncomfortable side effects with other treatments.
- Adalimumab (Humira)
- Golimumab (Simponi)
- Infliximab (Remicade)
Integrin receptor antagonists. These medications control inflammation by preventing inflammatory cells from entering intestinal tissue. The one used to treat UC is vedolizumab (Entyvio).
Interleukin-23 antagonists. These medications are monoclonal antibodies that target the protein interleukin-23 (IL-23).
- Guselkumab (Tremfya)
- Mirikizumab (Omvoh)
- Risankizumab (Skyrizi)
Interleukin-12 and -23 antagonist. Ustekinumab (Stelara) is a monoclonal antibody that blocks the proteins IL-12 and IL-23, which cause inflammation in the body.
The FDA also approved ustekinumab (Stelara) to treat moderate to severe ulcerative colitis in children ages 2 and older.
If you have questions about specific medications for UC, talk to your doctor. The Crohn’s and Colitis Foundation has also created a helpful online tool that can help answer your questions between appointments.
How Are Biologics Given?
Biologics are often large and complex molecules, like proteins or polypeptides. Because of this, many can't be taken orally. Doing so would mean the molecules get digested like food by the acids and enzymes in your digestive system, which would prevent the medication from working.
Because of this, the two most common ways biologic treatments are given are:
Infusions
These deliver the medication directly into your bloodstream. When you start treatment with biologic medications, they are usually given first through intravenous infusion (IV) at a health care facility, like a doctor's office or hospital. This allows medical professionals to monitor the process carefully.
This is what happens during an appointment:
- Before the appointment, follow the instructions your doctor gave you. This may include taking a medication before arriving at the health care facility for therapy.
- When you arrive at the health care facility, the staff will do a brief medical check.
- They will place an IV in your arm or hand to give you the medication.
- The medicine will be given slowly through the IV over a set period of time, which can range from 30 minutes to several hours, depending on the medication.
- During treatment, you can read, listen to music, talk with other patients, or just rest while the medical staff keeps an eye on the infusion process and how you feel.
- If you have any concerns or start feeling unwell during the procedure, speak with your care team.
- Once you receive all the medication, they will remove the IV.
- You might need to stay at the facility for a while after receiving the treatment.
Depending on the medication your doctor prescribed, you might continue receiving infusions for a long time. Some infusions can be given at home.
Shots
Biologic medications can also be given as shots. The needles used are small. They don't need to be long because the medication is placed just under the skin, not in the muscle.
Biologics are often given as shots after the person has already received several infusions.
Sometimes, you don't need to go to a health care facility to get your shots. Some are designed so you can give them to yourself at home, even from the first dose. It's very important that you feel comfortable doing this because you should never skip a dose.
What Are the Most Common Side Effects?
If you use biologics to treat your UC, you might have some side effects from the medication. The most common ones include:
- Redness, itching, bruising, pain, or swelling where the needle went in
- Headache
- Fever
- Chills
- Hives, rash, and other skin reactions
Some people may have severe allergic reactions to the medication. If you have symptoms like difficulty breathing, low blood pressure, dizziness, or vomiting, see a doctor immediately.
Are There Other Side Effects or Risks?
There are some risks associated with using biologics. Although they aren't common, it's important to know what they are before starting any medication. These include:
Infections. Biologic medications affect the immune system. This is how they help control inflammation. But by limiting immune response, they can also affect your body's ability to fight infections, like tuberculosis and hepatitis B.
Your doctor might do additional tests to see if you have any infections that aren't showing symptoms. If you already have one, the medication could activate or worsen it.
Another important step before starting a biologic treatment for any person with UC is to make sure they are up-to-date with all their vaccines, including those given once a year, like the flu vaccine.
Cancer. Studies have found that people using an anti-TNF medication for their UC might have a higher risk of developing lymphoma, especially if they are also using an immunosuppressant.
Lymphoma is a rare type of cancer. The risk of developing it is low but measurable among people using anti-TNFs.
Liver problems. Experts believe that, in rare cases, biologic medications could affect liver function. If you notice a yellowing of your skin or eyes, contact your doctor immediately.
Arthritis. Biologic treatments aren't only used for IBDs. Biologic medications are also prescribed for arthritis, and they've been shown to work well for treating this condition.
Despite this, in some cases, new joint pain has been reported after starting a biologic treatment, especially with anti-TNF medications.
Lupus-like reactions. In rare cases, an anti-TNF medication can cause drug-induced lupus (DIL). This can cause symptoms similar to lupus, like rash, joint pain, muscle pain, or fever.
If you stop taking the medication causing the symptoms, they will disappear, but you might need to take corticosteroids for a while to completely get rid of them.
Although it's uncommon, some people have reported developing psoriasis and other skin reactions after starting biologics. Nervous system disorders have also been reported.
This is why it's so important that you talk to your doctor before starting any new treatment. Tell them about other conditions you have, including nervous system issues, hepatitis, heart problems, and multiple sclerosis.
And don't forget to keep in contact with your health care team. If you start noticing changes in your body (like blurred vision or other changes in your eyes or vision) or new symptoms, report them to your care team immediately.
Why Did My Doctor Choose a Biologic Treatment?
Biologic treatments are often used to treat UC when it is moderate to severe. And if you have already tried other medications as part of your UC treatment, but they caused side effects or didn't have the desired effect, your doctor might prescribe a biologic treatment to help you achieve remission.
How Long Do Biologics Take to Work?
Your symptoms might improve in two to four weeks after starting treatment, but for some people, noticing significant improvement might take up to eight weeks.
Always remember that any question you have is valid, and you should ask your health care team. Learning about UC and its treatments will help you better manage your chronic condition and enjoy a healthy life.
Show Sources
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SOURCES:
FDA: “Biosimilar and Interchangeable Biologics: More Treatment Choices.”
American Gastroenterological Association: “Biosimilars.”
Arthritis Foundation: “Biologics.”
CDC: “Inflammatory Bowel Disease (IBD) Basics.”
Cleveland Clinic: “Biologics (Biologic Medicine).”
Crohn’s and Colitis Foundation: “Biosimilars: What You Should Know,” “Fact Sheet: Biologics.”
Mayo Clinic: “Ulcerative colitis,” “Crohn's disease.”
National Institutes of Health: “Adverse Reactions to Biologic Medications Used in Allergy and Immunology Diseases,” “Mirikizumab (Omvoh): CADTH Reimbursement Review: Therapeutic area: Ulcerative colitis.”
