Biologic medications can help control ulcerative colitis, but they take time to work and need monitoring. They may also need to be adjusted.
Sometimes, they can cause side effects or stop working. When that happens, it may be necessary to adjust your treatment or switch medications.
How Biologics Work for Ulcerative Colitis
Biologic medications are made from living organisms and work on the immune system to lower inflammation.
They help treat your ulcerative colitis symptoms, especially when the inflammation is active. The main symptoms include:
- Frequent diarrhea, often with urgency
- Rectal bleeding or pus in stool
- Abdominal pain and cramping
- Urgency to poop and a feeling of incomplete bowel movements (tenesmus)
- Fatigue and general tiredness
- Loss of appetite and weight
By lowering inflammation, biologics ease symptoms and help decrease flare-ups. This keeps the disease under control in the long term.
How Does Your Doctor Choose Your Biologic?
Biologic medications can be given in two ways:
- By intravenous (IV) infusion, done at authorized medical centers
- As a shot under the skin, which you can give yourself at home
Your doctor will consider the following things in order to prescribe the best biologic medication for you:
- If you can give yourself the shots
- How close you are to an infusion center
- How active or severe your inflammation is
- If you have had previous infections or cancer
- Your age
- If you have fistulas
- If you are pregnant
In some cases, your health insurance coverage may influence the choice of treatment.
How people respond to treatment varies. Your doctor will continuously monitor you and make necessary adjustments until they find the best option for you.
Side Effects of Biologics
Biologic medications can cause side effects, though they are usually mild and manageable. The most common ones include:
- Redness, pain, itching, or swelling where the needle went in
- Fatigue
- Headache
- Flu-like symptoms
- Nausea
In less common cases, biologics can increase the risk of infections or worsen other diseases.
The following require medical attention or monitoring:
- Serious infections, like TB (tuberculosis) or pneumonia
- Severe allergic reactions
- Higher risk of certain types of cancer
How to Know if the Biologic Is Working
Your doctor will determine how well the treatment is working based on how you feel and the results of your medical tests.
The most common signs of improvement include:
- Less diarrhea, cramping, and blood or pus in stool
- Less frequent flare-ups
- More energy and less difficulty with daily activities
- Maintaining a stable weight or gaining weight
After a year of treatment without ulcerative colitis flare-ups, your doctor may order tests to confirm that you're in remission. They can check this in three ways:
Endoscopic remission: There is no visible inflammation during a colonoscopy.
Histological remission: The tissue shows no inflammation when analyzed in the lab.
Biochemical remission: Blood or stool tests show no inflammation.
Remember that biologics help control ulcerative colitis flare-ups in the long term. If symptoms disappear, don't stop taking your biologic medication without talking to your doctor.
How to Treat Side Effects
You can treat the most common side effects at home by:
- Staying hydrated
- Avoiding sweets or fried foods
- Resting if you feel tired
- Applying cold compresses to the area that hurts
Ask your doctor if you can use pain medication for headaches.
How to Identify Good Results
It's common for your ulcerative colitis symptoms to slowly improve during the first weeks of treatment. But everyone reacts differently, and some medications may work faster than others.
The common stages of symptom relief include:
- Improvement of symptoms during the first weeks
- More noticeable changes between weeks 8 and 12
- Symptom remission after about 52 weeks
It's common for your doctor to start with a low dose and slowly increase it.
When to Change Your Biologic
There are different types of biologics, and your doctor can change your medication if they find that the treatment isn't working.
Common signs the medication needs to be changed or adjusted include:
- Lack of improvement after a reasonable treatment time
- Return of symptoms after initial improvement
- Increased pain, diarrhea, or bleeding in stool
- More frequent flare-ups
- Persistent inflammation in lab or imaging tests
Your doctor will order tests to rule out a possible infection. If there is no infection, they may adjust the medication dose or consider switching you to another biologic.
Is It Common to Switch Biologics?
Switching biologics is common when treating ulcerative colitis symptoms.
The most frequent reasons include:
- Return of symptoms over time
- Developing antibodies against the medication
- Side effects that make it hard to continue treatment
Increasing the dose or switching your biologic medication usually helps control symptoms.
What to Expect When Switching Biologics?
Being prepared for the transition to a new biologic is key to avoid treatment interruptions.
You can prepare yourself for the switch by:
- Getting approval from your health insurance before changing your medication
- Learning about the new medication
- Scheduling your infusion appointments or ordering your shots in advance
The goal is to keep the disease under control during the switch.
Tests to Check How Well Your Biologic Is Working
Follow-up tests help your doctor check how well your biologic treatment is working and decide if changes are needed
They may include:
- Mayo Score, a tool used to estimate ulcerative colitis activity based on your symptoms and colonoscopy results
- Blood tests to check for signs of inflammation
- Stool tests to measure inflammation in the intestine
- Imaging studies like MRIs or CT scans
- Colonoscopies to check that the intestine is healing
How to Check How Well Your Biologic Is Working at Home
Keep track of your symptoms to help your doctor better understand how you're reacting to the treatment.
Write down the following:
- Frequency and consistency of bowel movements
- Intensity of abdominal pain
- Your energy levels
- Changes in your weight
- Hours you sleep every day
- Foods that cause discomfort
- Side effects after infusions or shots
How to Get the Most Out of Your Treatment
Being consistent with your treatment is vital for getting the best results.
Make sure you do the following:
- Don't skip doses.
- Set up reminders for shots or infusions.
- Keep up with your medical appointments and follow-up tests.
- Stay in regular contact with your doctor.
Healthy habits, like managing stress, getting enough sleep, and following nutritional guidelines tailored to your symptoms, can help your biologic treatment work better.
Habits That Support Your Biologic Treatment
Even if you're following a biologic treatment, it's common to have ulcerative colitis symptoms. These habits help control flare-ups:
- Avoid dairy products.
- Limit high-fiber foods.
- Eat small portions.
- Reduce stress with techniques like meditation or therapy.
- Drink water throughout the day.
Important Facts to Remember
- Biologics can help control ulcerative colitis symptoms.
- Biologics may take weeks or months to work.
- You can usually tell if the treatment is working if you notice a reduction in symptoms.
- The treatment may not be working if symptoms continue or come back.
- Switching biologics is common and doesn't mean the treatment failed.
- Your doctor will do tests and follow-up exams, even if you feel better.
- Keeping track of your symptoms helps you and your care team make informed treatment decisions.
- Being consistent with your doses is key for the treatment to work.
- Side effects are usually mild and manageable.
- Biologics can increase the risk of infections and, in some cases, the risk of conditions like cancer, so they require medical monitoring.
Show Sources
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