If you have moderate to severe ulcerative colitis and aren't responding to or can’t tolerate traditional medications, such as aminosalicylates (5-ASAs) or immunomodulators, your doctor may recommend a biologic.
Biologic drugs, such as adalimumab and infliximab, have been shown to stop inflammation and maintain remission when other ulcerative colitis medications aren’t effective. Biologics are complex drugs, so it’s important to learn more about them.
- Biologic therapy can lead to long periods of remission.Biologics decrease chronic inflammation. "We’re seeing fewer hospital admissions, fewer surgeries, and less disability from ulcerative colitis with the use of these drugs,” says Thomas Ullman, MD, an associate professor of gastroenterology at the Icahn School of Medicine at Mount Sinai in New York City.
- Biologics are targeted ulcerative colitis medication. While many ulcerative colitis medications impact the entire immune system, biologics are designed to block specific steps in the inflammatory process.
- Biologics aren’t considered a first-line treatment. Although doctors are learning that it’s better to start a biologic 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,” Dr. Ullman says.
- Biologics are given by injection. Some biologic medications are available as a shot once or more every month, which you or a loved one will learn how to administer at home. Others require an intravenous (IV) infusion, which might be repeated every eight weeks and could take about two hours each session.
- Biologics may be used along with other ulcerative colitis medication. “A biologic medication combined with a traditional ulcerative colitis drug may work better than either drug alone," Ullman says. However, two biologics shouldn’t be taken together because of an increased risk of complications.
- You may need to try different biologics. If one biologic drug doesn’t work for you, your doctor may suggest switching to another one, Ullman says.
Biologics have some side effects and long-term risks. The most common side effects of biologic drugs include injection site reactions, like redness, itching, rash, swelling, and painful lumps under the skin. You might experience headaches, fever, chills, nausea, aches and pain, cough, and a sore throat. Reactions may differ depending on the biologic medication you take.
Biologics change the way your immune system works, so the biggest risk is increased risk of infection, Ullman says. Tuberculosis, hepatitis B, or fungal infections may be reactivated. You may be at higher risk for more common infections, and there's a slightly higher risk for developing a blood cancer called lymphoma. Biologics may make some heart conditions worse — you may not be able to take a biologic if you have heart failure. And there aren’t enough studies to say that biologic drugs are safe during pregnancy or while breastfeeding. Talk to your doctor in detail about all of these risks before taking a biologic medication for ulcerative colitis.
- Biologics are long-term maintenance drugs. Once you start a biologic medication, you need to keep taking it to prevent ulcerative colitis from flaring. Unless advised by your doctor, don’t stop treatment on your own.
- Biologics are expensive. A biologic drug may cost about $1,000 or more per month. Before starting to take a biologic medication, make sure you can afford it either through 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.
- Know the dos and don'ts of your particular drug. Be sure to tell your doctor about any signs of infection right away when you’re taking a biologic drug. These include fever, fatigue, cough, or flu-like symptoms. Don’t take any other drugs, including over-the-counter medications or supplements, without checking with your doctor first. Be sure to follow any additional guidelines your doctor gives you.
Biologic drugs are changing the way doctors treat ulcerative colitis and they may make a big difference for you if you’re struggling with moderate to severe symptoms that aren’t helped by traditional medications. As with any treatment, weigh all the risks and benefits of taking a biologic medication carefully with your doctor.