Biologic drugs, such as adalimumab and infliximab, can help stop inflammation and keep your disease in remission if other UC medications aren’t effective. But these drugs are also complex and may not work for everyone, so it’s important to learn more about them if you’re new to biologic therapy. Here are 10 key facts about biologic drugs for UC.
1. Biologics aren’t considered a first-line treatment.
Although many doctors believe it’s better to start a biologic drug sooner rather than later, it’s not likely to be your first ulcerative colitis treatment. “The current indications for biologics in ulcerative colitis are for people who haven’t responded to traditional medications or are dependent on corticosteroids to relieve their symptoms,” says Thomas Ullman, MD, chief of the division of gastroenterology at the Albert Einstein College of Medicine in New York City. It’s possible, though, that your doctor will recommend a biologic early in the course of your treatment if your ulcerative colitis reaches a certain threshold of severity. This decision will likely depend on your doctor’s personal judgment and experience.
2. Biologics are targeted medications.
While many UC medications have wide-ranging effects on your immune system, biologics are designed to block specific steps in the inflammatory process. One group of biologic drugs for UC, known as anti-TNF drugs or TNF inhibitors, block a protein called tumor necrosis factor alpha (TNF alpha) that promotes inflammation in your intestines and certain other organs. Another type of biologic, integrin receptor antagonists, blocks a protein on the surface of cells that can move out of blood vessels and into certain tissues.
3. Biologics are given by injection.
Some biologic medications are available as a shot that’s given once or more every month, with more frequent “starter” doses in the beginning. You or a loved one can learn to administer these injections at home. Other biologics require an intravenous (IV) infusion, which typically happens every 8 weeks after several initial infusions. Depending on the drug, an infusion can last about 30 minutes or 2 to 4 hours.
4. Biologics may be used along with other UC medication.
“A biologic medication combined with a traditional ulcerative colitis drug may work better than either drug alone,” Dr. Ullman says, but two biologics shouldn’t be taken together because of an increased risk of complications. Current guidelines also state that if you previously took a 5-ASA that wasn’t successful, you shouldn’t keep taking it if you move on to an anti-TNF drug, such as adalimumab or infliximab.
5. It may take time for biologic drugs to take effect.
When you start taking an anti-TNF drug, it may take up to 8 weeks to notice any improvement in your UC symptoms, according to the Crohn’s and Colitis Foundation. While some people notice an immediate improvement, the possibility of a delayed effect means you’ll need to continue your treatment for several weeks before concluding that it isn’t effective, if that turns out to be the case.
6. You may need to try different biologics.
If one biologic doesn’t work for you, your doctor may suggest switching to another one. Current guidelines from the American College of Gastroenterology also suggest that if anti-TNF therapy isn’t effective, you may want to try vedolizumab (an integrin receptor antagonist).
7. Biologic therapy can lead to long periods of remission.
Biologics are broadly effective at reducing chronic inflammation in UC. “We’re seeing fewer hospital admissions, fewer surgeries, and less disability from ulcerative colitis with the use of these drugs,” says Ullman. They are also long-term maintenance drugs, so once you start on biologic therapy, you’ll need to keep taking it to prevent your UC from flaring. Don’t stop treatment without consulting with your doctor.
8. Biologics may become less effective over time.
While it isn’t exactly clear why, some people have an initial response to a biologic but lose this response over months or years of treatment. When this happens with an anti-TNF drug, your doctor may recommend trying a different anti-TNF drug or vedolizumab (an integrin receptor agonist).
9. Biologics have some side effects and long-term risks.
The most common side effects of biologic drugs include injection site reactions, such as redness, itching, rash, swelling, or painful lumps under your skin. You might also experience headaches, fever, chills, nausea, aches and pains, a cough, or a sore throat. Reactions may differ depending on which medication you take. Biologics change the way your immune system works, so the biggest risk is a higher susceptibility to infection, Ullman says. A previous tuberculosis or hepatitis B infection may be reactivated when you start on biologic therapy, so it’s important to screen for these conditions before getting started. You may also be at higher risk for more common infections, so it’s important to get vaccinated for the flu and pneumonia according to your doctor’s recommendation. Be sure to tell your doctor about any signs of infection right away, such as fever, fatigue, cough, or flu-like symptoms. Some biologic drugs are associated with a slightly higher risk of developing a blood cancer called lymphoma. In rare cases, biologics may also cause liver problems, joint pain, or nervous system problems. Talk to your doctor about all of these risks before starting on a biologic.
10. Biologics are expensive.
The “sticker price” of biologic drugs can be high. But if you have health insurance, you’re not likely to pay the full price of any infusion drug or its administration. Before starting on biologic therapy, make sure you can afford it through either your insurance coverage or your own finances. “In most cases, insurance companies do cover biologics, and most drug companies offer financial assistance programs to help cover the cost,” Ullman says. Additional reporting by Quinn Phillips
