Remission is the primary goal for people with Crohn’s disease. Biologic therapies can help achieve remission by reducing symptoms, as well as healing damage to intestines caused by inflammation.
Biologic therapies are usually prescribed in people with more severe Crohn’s symptoms who haven’t found relief with other methods. Guidelines now recommend, however, that doctors prescribe biologics for patients with significant disease as a first-line approach, too.
Biologic therapies work by blocking certain chemicals that cause inflammation in your intestines.
Most biologics for Crohn’s disease block a protein called tumor necrosis factor (TNF). Other biologics block immune cells called integrins, and others act on proteins called interleukin-23 (IL-23) and interleukin-12 (IL-12). This is how biologic therapies stop inflammation in the gut.
Anti-TNF biologics bind and block a protein that promotes inflammation in the intestines and also other organs and tissues. Many people benefit from these medications, sometimes seeing an improvement immediately, or anywhere up to eight weeks.
The three anti-TNF biologics are Humira, Remicade, and Cimzia.
Humira is a self-administered treatment following an initial demonstration by a healthcare professional. If your doctor decides you can handle the injections yourself, they’ll give you a set of pens with dosage-controlled medication inside.
You’ll also be given instructions on how many injections to take for the first 30 days. After the initial 30-day period, patients typically use one Humira pen every two weeks.
Remicade may help patients gain control of flare-ups. It may also help maintain remission to prevent symptoms from returning.
Remicade is given directly into the bloodstream. This allows it to work immediately to relieve symptoms. It’s administered in a medical facility. Experienced healthcare professionals will be close by to monitor for side effects during and after treatment.
Remicade doesn’t have to be taken every day. After three starter doses, a patient often sees benefits in as few as six doses per year. The downside is that Remicade must be given intravenously in a medical facility over a two-hour period.
Cimzia is administered by a small injection. The injection can either be given in a doctor’s office or at home.
If you choose to receive treatment in a doctor’s office, you have the option of receiving your treatment in powder form. The powder is mixed with sterile water and then injected.
The other option is to use prefilled syringes. The syringes contain medication that’s already mixed in measured doses. These can be used at home or in a doctor’s office.
If you choose to do the treatments yourself, you’ll get a package with two syringes and instructions on giving the treatment. After the first three doses, given every two weeks, you will be able to take Cimzia once every four weeks.
The two anti-integrin biologics for Crohn’s are Tysabri and Entyvio.
This type of biologic prevents inflammation-causing white blood cells to enter tissues by blocking a protein on the surface of these cells.
Tysabri is given intravenously every four weeks. It takes about an hour to receive the full dose. Patients are usually observed for an hour afterward. Tysabri is typically used for people who haven’t responded well to or are intolerant of a TNF blocker, immunomodulator, or corticosteroid.
Crohn’s patients considering Tysabri should be aware of a very serious side effect. Tysabri users have an increased risk of developing a rare brain disease called progressive multifocal leukoencephalopathy (PML). This results from a virus, which you can be tested for in advance.
Any physician who prescribes Tysabri for Crohn’s will warn patients of those risks. They will also explain how to enroll in a prescribing program called TOUCH. This program is the only way you can receive Tysabri.
Like Tysabri, Entyvio is approved to treat adults with moderate to severe Crohn’s disease who haven’t responded well to, are intolerant of, or for other reasons can’t take a TNF blocker, immunomodulator, or corticosteroid.
It works similarly to Tysabri, acting on certain white blood cells to prevent them from causing the bowel inflammation associated with Crohn’s. Entyvio, however, is gut-specific and doesn't appear to have the same risk of PML.
Entyvio is given under a doctor’s care as an intravenous infusion. It’s given over 30 minutes on the first day of therapy. It’s then repeated on week two, on week six, and every eight weeks thereafter.
If no improvement in Crohn’s disease symptoms occurs by week 14, Entyvio therapy should be discontinued. Prior to starting Entyvio, patients should be up-to-date on their immunizations.
The third class of biologics is the IL-12 and IL-23 agonists.
Stelara is the drug in this class approved for treating adults with moderately to severe Crohn's who haven’t responded well enough to conventional therapy. The drug targets specific proteins that play a key role in the inflammation process.
Stelara is initially given intravenously under the supervision of a healthcare professional. The following doses can be given via an injection under the skin every eight weeks, either by a healthcare provider or self-administered by the patient with training.
Although the benefits often far outweigh the risks, biologic therapies present serious side effects. The process of biologic therapy reduces the body’s ability to fight infections. This can cause tuberculosis and other infections, including brain infections.
There’s also an increased chance of certain types of cancer in patients taking biologics, especially in younger patients. One is called hepatosplenic T-cell lymphoma. This type of cancer is often fatal.
Because some biologic therapies work differently than others, the side effects they may cause can also vary. Ask your doctor to thoroughly explain all possible side effects when discussing which biologic therapy is right for you.
Biologics offer an advantage in treating Crohn’s disease because these drugs are specifically targeted at the substances in your body that cause the bowel inflammation. Your doctor can discuss all the options, their benefits and risks, and help you find the most effective treatment.
In some cases, “biosimilars” (generic versions of biologic drugs) may be available, which can manage your Crohn’s and also save money. Your doctor can tell you if this is an option.