Dr. Qin Rao, an ABMS board certified internal medicine physician specializing in gastroenterology and hepatology, spoke with Healthline about when people with ulcerative colitis (UC) might consider biologic therapy to manage their condition.
Biologics are medications, usually given as an infusion or an injectable, that use antibodies to target proteins that control the immune system. By attaching to specific proteins, the medication shuts down the chain of events that causes inflammatory bowel disease, such as Crohn’s disease or UC.
Biologics include:
- anti-TNF (anti-tumor necrosis factor)-alpha antagonists (e.g., infliximab, adalimumab)
- anti-integrin inhibitors (e.g., vedolizumab)
- anti-interleukin inhibitors (e.g., ustekinumab)
Doctors prescribe biologics for several reasons, most commonly based on disease severity. People with moderate to severe UC generally start taking biologic therapy to induce remission and then continue maintenance.
Another reason to start biologic therapy is because a person has a contraindication to less aggressive treatments such as mesalamine or immunomodulators.
The type of biologic a doctor prescribes first depends on several factors, including patient preference, prior treatments, the severity of the disease, and insurance coverage.
For example, a person with severe disease who you’d want to induce remission quickly may benefit from infliximab, which is faster-acting than other biologic agents.
People whose lifestyles require frequent travel might benefit from an injectable pen such as adalimumab rather than going to receive infusions every 8 weeks.
People who have previous exposure to biologics and have been shown to have antibodies may benefit from avoiding them in the future.
Finally, a doctor may prescribe a biologic such as vedolizumab because it’s more gut-selective and may have fewer side effects due to how it’s absorbed compared with other biologics.
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The mean persistence rate — defined as stopping a medication for any specific reason or due to loss of data — was 5.5 years for adalimumab, 10.1 years for infliximab, and 3.6 years for vedolizumab.
Based on clinical trials:
17.3% of those treated with adalimumab achieved remission after 1 year, compared with 8.5% of those who did not take adalimumab.42% of those treated with vedolizumab achieved remission after 1 year, compared with 16% of those who did not take vedolizumab.- 35% of those treated with infliximab achieved remission after 1 year, compared with 17% of those who did not take infliximab.
- 43.8% of those treated with ustekinumab achieved remission after 1 year, compared with 24% of those who did not take ustekinumab.
You can take biologic drugs indefinitely, but a doctor should monitor you for potential complications and side effects. Generally, a doctor will check routine lab work, such as blood count and liver chemistry, while you’re taking the medication.
They may also check for tuberculosis and hepatitis B once a year as well as monitor drug levels and antibodies as needed.
Some people choose to discontinue biologic therapy after a period of remission. However, studies have shown that there is a high risk of recurrence.
For example, a
Researchers compared these relapse rates with a control group that only had an incidence of relapse of 10% at 12 months and 18% at 36 months.
People
- advanced cardiac failure
- certain neurological conditions such as multiple sclerosis, optic neuritis, and lupus-like disease
- active infections such as tuberculosis, fungal infections, or sepsis
- allergic or hypersensitivity reaction and infusion reaction
Dr. Qin Rao is an ABMS board certified internal medicine physician specializing in gastroenterology and hepatology. He is currently a practicing physician at Manhattan Gastroenterology in New York City, specializing in irritable bowel syndrome, inflammatory bowel disease, dyspepsia, and hemorrhoid treatment.