If you have tried other treatments for Crohn’s disease and they haven’t worked, you might consider biologic drugs. Biologics are prescription drugs that help reduce harmful inflammation from Crohn’s disease.
What Are Biologic Therapies?
Biologics are genetically engineered medicines that target certain molecules in the body involved in causing inflammation.
Doctors often prescribe biologics to those with refractory Crohn’s disease, or those with moderate to severe symptoms that aren’t going away with other medications. Before biologics, there were few nonsurgical treatment options for people with refractory disease.
Biologic therapies work to quickly bring on remission. During a period of remission, inflammation and intestinal symptoms go away. Biologics may also be used on a long-term basis to help maintain periods of remission.
Types of Biologics
The type of biologic your doctor recommends will depend on the severity of your symptoms and the location of disease.
Everyone is different, so a particular biological drug may work better for some than others. You may have to try a few different medications before finding what works for you.
Biological therapies for Crohn’s disease fall into one of two categories: anti-TNF therapies and anti-integrin antibodies.
Anti-TNF therapies target a protein that’s involved in intestinal inflammation. Anti-integrins block certain immune system cells that cause inflammation.
Biologics are typically given either subcutaneously (with a needle through the skin) or intravenously (through an IV tube). They may be given every two to eight weeks, depending on the medication. You’ll have to go to a hospital or clinic for most of these treatments.
The FDA has approved several biological drugs to treat Crohn’s disease.
Anti-TNF medications include:
adalimumab (Humira, Exemptia)
certolizumab pegol (Cimzia)
infliximab (Remicade, Remsima, Inflectra)
Anti-integrin antibodies include:
natalizumab (Tysabri)
vedolizumab (Entyvio)
Step-Up vs. Top-Down Treatment
Biologic therapies can be a powerful tool in the treatment and management of Crohn’s disease. There are two different approaches to biologic therapy:
Step-up therapy is the conventional approach and means that you and your doctor try several other treatments before starting a biologic.
Top-down therapy means that biologic medications are started much earlier in the treatment process.
The medical community is split on which approach works best. There may not be one right answer. Different approaches may work better for different people depending on the severity and location of disease.
Side Effects
Biologics tend to have fewer and less harsh side effects than other Crohn’s disease medications, such as corticosteroids, which suppress the entire immune system.
Still there are certain side effects you should know about before taking a biologic medicine.
Some common side effects of biologics include:
redness, itching, bruising, pain, or swelling around the injection site
headache
fever or chills
difficulty breathing
low blood pressure
hives or rash
stomach pain
back pain
nausea
cough or sore throat
Special Considerations
Biologics may not be safe for everyone. Talk to your doctor if you have tuberculosis (TB), are prone to infections, or have a heart condition.
Tuberculosis
Anti-TNF drugs can increase the risk of reactivating a tuberculosis infection in people who have been exposed. TB is a serious, infectious lung disease.
Your doctor should test you for TB before starting therapy with an anti-TNF drug. A TB infection can be dormant in the body, so some people who have been exposed to the disease might not know it. If you’ve had prior exposure to TB, your doctor may recommend TB treatment before taking an anti-TNF.
Infections
Biologics can lower the body’s ability to fight other infections. If you’re prone to infections, you doctor may suggest a different type of therapy.
Heart Conditions
Biologic drugs may be risky for people with certain heart conditions, including heart failure. Heart failure is when the heart can’t pump enough blood to meet the body’s needs.
Tell your doctor immediately if you experience shortness of breath or swelling of the feet while taking a biologic for Crohn’s disease. These may be signs of heart failure.
Other Issues
On rare occasions, biologic therapies have been associated with serious health problems. In people taking anti-TNF drugs, the following health problems are infrequently reported:
certain blood disorders (bruising, bleeding)
neurological problems (including, numbness, weakness, tingling, or visual disturbances, such as blurred vision, double vision, or partial blindness)
lymphoma
liver damage
severe allergic reactions
Talk with your doctor to determine the best therapy for you and your needs.