Remission is the primary goal for people with Crohn’s disease. Biologic therapies can help you achieve remission by reducing symptoms, as well as provide healing for 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 people 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 your intestines and also other organs and tissues.
Many people benefit from these medications, sometimes seeing an improvement immediately or anywhere up to 8 weeks.
The three anti-TNF biologics are:
Humira is a self-administered treatment following an initial demonstration by a healthcare professional.
If your doctor decides you can do 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 2 weeks.
Remicade may help people better manage flare-ups. It may also help maintain remission to prevent symptoms from returning.
Remicade is given directly into the bloodstream, which 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 people often see benefits in as few as six doses per year.
The downside is that Remicade must be given intravenously in a medical facility over a 2-hour period.
Cimzia is administered via a small injection. The injection can either be given in your doctor’s office or at home.
If you choose to receive treatment in your 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 2 weeks, you’ll be able to take Cimzia once every 4 weeks.
The two anti-integrin biologics for Crohn’s are:
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 4 weeks. It takes about an hour to receive the full dose.
You’re 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.
People with Crohn’s who are considering Tysabri should be aware of a very serious side effect.
People taking Tysabri have an increased risk for a rare brain disease called
Healthcare providers who prescribe Tysabri for Crohn’s will warn you of those risks. They’ll 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 2, on week 6, and every 8 weeks thereafter.
If no improvement in Crohn’s disease symptoms occurs by week 14, Entyvio therapy should be discontinued. Prior to starting Entyvio, make sure you’re up to date on your 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 8 weeks by a healthcare provider or by self-administering after you’re trained.
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 those taking biologics, especially in younger people. One is called hepatosplenic T-cell lymphoma. This type of cancer is often fatal.
Some common side effects of biologics include:
- redness, pain, itching, or swelling around the injection site
- low blood pressure
- hives or rash
- stomach pain
- fever or chills
- cough or sore throat
- difficulty breathing
- back pain
Biologics may not be safe for everyone. Talk to your doctor about considerations if you:
- have tuberculosis (TB)
- have a heart condition
- are prone to infections
TB is a serious, infectious lung disease. Biologics used for Crohn’s disease can increase the risk of reactivating a dormant TB infection in people who have been previously exposed.
Your doctor should test you for TB before starting any Crohn’s therapy with a biologic. Some people who’ve been exposed to the disease might not know it. Your doctor may recommend TB treatment before taking a biologic.
Because biologics can reduce your ability to fight infection, your doctor may suggest a different type of therapy if you’re more susceptible.
Anti-TNF medications have an elevated risk for people with certain heart conditions. This includes heart failure, which is when the heart can’t pump enough blood to the body.
Tell your doctor as soon as possible if you experience swelling of the feet or shortness of breath while taking a biologic for Crohn’s disease. These could be signs of heart failure.
Biologic therapies have sometimes been linked with other serious health problems. In people taking biologics, the following health problems have been sometimes (though rarely) reported:
- certain blood disorders (bleeding, bruising)
- severe allergic reactions
- liver damage
- neurological problems, including numbness, weakness, tingling, or visual disturbances, such as blurred vision, double vision, or partial blindness
Talk with your doctor to determine the best therapy for you.
Biologics offer an advantage in treating Crohn’s disease because these drugs specifically target the substances in your body that cause the bowel inflammation.
Your doctor can discuss all the options and their benefits and risks. They can also help you find the most effective treatment.
In some cases, “biosimilars,” which are generic versions of biologic drugs, may be available. They can help manage your Crohn’s and also help you save money.
Your doctor can tell you if this is an option.