In 1932, Dr. Burrill Crohn and two colleagues presented a paper to the American Medical Association describing the intricacies of what we now call Crohn’s disease — an inflammation of the digestive tract that can cause cramps, diarrhea, nausea, and other disruptive stomach issues.
Since then, treatment options have evolved to include biologics, which are drugs made from living cells that are designed to target inflammation.
When your inflammation is suppressed, your body can go into remission, and you may experience little to no symptoms. When you’re experiencing a Crohn’s flare, your inflammation has returned, and symptoms can reappear.
While there’s no cure for Crohn’s, the goal of treatment is to reduce inflammation to put the disease into remission and keep it there.
There’s no set time limit for being on a biologic. For many people living with Crohn’s, taking a biologic is a way to alleviate their symptoms and go into a period of remission. During this quiet period, their intestines can start to heal.
If someone has been taking a biologic for a longer period of time and has been living in remission, they may — after discussing it with their doctor — opt to stop taking it. Side effects of the medication may also be a reason someone transitions off a biologic.
The length of time you decide to stay on a biologic is a personal choice informed by routine testing, discussions with your doctor, and how you’re feeling.
Recent studies show that 20 to 40 percent of people who stop taking either biologics or immunosuppressants for Crohn’s did not experience relapses of their disease during a follow-up period of several years.
So it’s possible that if you’ve been on a biologic for a while and you haven’t been having flares, your disease could go into remission for a period of time after you stop taking the medication.
However, it’s also just as likely that you’ll experience a relapse in your Crohn’s after you stop taking a biologic, which means symptoms may appear again. In this instance, restarting the same biologic or trying a different medication is a decision you’ll make with your doctor.
In some cases, certain people are unable to take the same biologic after stopping it because their body has developed a resistance to it.
Because biologics suppress your immune system, they put you more at risk for infection. Because of this, there are certain situations where your doctor may advise you to take a medication break. These include:
It’s never advised to stop taking your medication cold turkey, as flares and side effects from a sudden cutoff can be severe.
Tumor necrosis factor, or TNF, is a protein that induces inflammation as part of an immune system response. Anti-TNF biologics work by targeting this protein to reduce its inflammatory properties.
If you take Remicade (infliximab), Humira (adalimumab), Cimzia (certolizumab), or Simponi (golimumab), you’re taking an anti-TNF biologic.
With Crohn’s disease, your immune system sends too many white blood cells to the gastrointestinal (GI) tract, which triggers inflammation. Another way that biologics target inflammation is by addressing the issue of having too many white blood cells in the GI tract.
Entyvio (vedolizumab) and Tysabri (natalizumab) work this way. They stop white blood cells from entering the stomach. This blocking action keeps the white blood cells away from the gut, where they would otherwise cause inflammation. In turn, this allows the area to heal.
Biologics can target other pathways in the body that lead to inflammation. Stelara (ustekinumab) is an interleukin inhibitor. It targets two specific proteins that are thought to cause inflammation. People with Crohn’s have higher levels of these proteins in their bodies.
By targeting these proteins, Stelara blocks inflammation in the GI tract and decreases symptoms of Crohn’s disease.
It’s normal to have good days and bad days when you have Crohn’s, so how do you know whether you’re in remission and not just having several good days?
Clinical remission is when you’ve gone for an extended period of time, usually for a year or more, without having to deal with any symptoms.
Most people taking medication from Crohn’s are monitored by their doctor for both medication side effects and biomarkers of inflammation. If you’ve been symptom-free for 6 months to 1 year and your doctor hasn’t detected any rising levels in routine lab tests, you’re in clinical remission.
Biologics keep you in remission by blocking your immune system’s overactive inflammation response. While it’s possible to experience flare-ups for no apparent reason while taking a biologic, certain lifestyle factors increase the likelihood of remission via their ties to heightened inflammation in the body:
- cigarette smoking
- medication changes
- air pollution
- high consumption of red meat, sugars, and refined grains
Managing your stress levels, maintaining a nutrient-dense diet, avoiding personal food triggers, staying active, taking your medication as prescribed, and communicating openly with your doctor are all habits that can increase the likelihood of prolonged remission.
As their name suggests, biosimilars are near-identical copies of an already approved biologic. They’re taken the same way as the original drug and have the same safety and effectiveness.
These Food and Drug Administration (FDA)-approved alternatives were designed to increase access to medications and potentially lower healthcare costs through competition.
When taken as prescribed, it’s possible that your biologic can help put your Crohn’s disease into remission. However, because of how personalized Crohn’s can be in terms of triggers, flare severity, and medication effectiveness, it’s not a guarantee.
Adhering to helpful lifestyle choices, working with your doctor to find a biologic that works for your system, and giving it time to do its job can increase your chances of long-term clinical remission.