Biologics are a relatively new class of medications that can help provide immense relief in the symptoms of various conditions including Crohn’s disease. These drugs are known to keep your symptoms in remission and your doctor might consider prescribing biologic drugs if you suffer from moderate to severe Crohn’s that is failing to show signs of improvement with other treatments. Unlike other drugs that are used for treating Crohn’s disease, biologic drugs will not suppress your entire immune system, and will instead only target the specific proteins and cells that are responsible for causing inflammation in the gut, thus providing you with relief from your symptoms. However, like with all treatments, there are several side effects and risks associated with biologic drugs as well. So what exactly is involved with using biologics for Crohn’s disease and do they work?
Overview of Crohn’s Disease and Biologics
Crohn’s disease is a chronic inflammatory bowel disorder. The disease can affect any portion of the gastrointestinal tract, but it is more likely to affect the end of the colon, the small intestine, or both. There is no cure for Crohn’s and the treatment focuses on aiming towards disease remission.
If you find that your present treatment for Crohn’s is not working too well and you are not getting much relief from your symptoms, then your doctor may consider putting you on biologics. The entry of biologics has revolutionized the medical world. These are medications that are manufactured from the living cells and specifically target the inflammation response of the immune system. Biologic drugs work best for moderate to severe Crohn’s, especially the cases where no conventional therapy seems to be working.
However, like all other treatments, biologics are also not without side effects and risks. While biologics work well in lowering the inflammation and slowing down the progression of the disease, they also increase the risk of various infections and certain types of cancers as well.
Many doctors will only prescribe biologics when no other therapy is working, while other doctors begin the treatment itself with biologics so that it stops any intestinal damage from happening.
Unlike the other medications commonly prescribed for treating Crohn’s disease, biologics do not suppress the entire immune system. These drugs are antibodies that only target the specific proteins and cells that are responsible for causing inflammation in the gut. This ensures that you experience relief from your symptoms, while also avoiding the major side effects associated with the conventional medications for treating Crohn’s.
Some of the commonly used biologics for treating Crohn’s disease are certolizumab pegol (brand name Cimzia), adalimumab (brand name Humira), and infliximab (brand name Remicade) that are part of the anti-TNF-alpha antibodies, which work by inhibiting a protein known as tumor necrosis factor-alpha. There is also natalizumab (brand name Tysabri), which works by preventing the white blood cells from traveling to the inflamed part of the gut and causing further damage.
The drugs Humira, Remicade, and Cimzia, even carry a warning on the box for increasing the risk of serious infections that may even lead to hospitalization or death. If while taking a biologic drug you develop an infection, then the drug needs to be discontinued immediately. People who suffer from heart troubles, tuberculosis, or multiple sclerosis, should not take biologics as it may worsen their condition.
On the other hand, the biologic Tysabri increases the risk of developing a fatal brain infection known as progressive multifocal leukoencephalopathy (PML). The drug Tysabri can also lead to liver damage and cause allergic reactions in many people. Be mindful that Tysabri cannot be used along with other treatments that are known to suppress the immune system, or in combination with TNF inhibitors.
You need to work together with your doctor to understand the risks and benefits associated with biologic drugs so that you can make a well-informed decision about whether or not to introduce biologics into your treatment plan.
Should You Consider Taking a Biologic for Crohn’s?
Well whether or not you should take a biologic for your Crohn’s depends on many factors, such as.
- What is the severity level of your Crohn’s Disease?
- What treatment option do you prefer?
- What other treatments have you tried already?
- What is your doctor’s approach to your treatment?
What to Expect from Biologics Treatment for Crohn’s Disease?
There are many things that you have to consider before you decide to go ahead with biologic drugs for treating your Crohn’s Disease. These factors are discussed below.
You Cannot Take Biologics Orally. First and foremost, you need to be aware that biologics cannot be taken orally. You will need to take them either through an injection or through intravenously (IV). This is because the strong stomach acids destroy the complexity of the drugs. Crohn’s Disease patients have the biologics injected subcutaneously, meaning that the drugs get deposited in the fat layer that is present between the muscle and the skin. From here, the medicine is absorbed slowly into the body. It is possible to give yourself the injections or you can also have them administered by a medical professional. On the other hand, IV doses of the medication are only given at a doctor’s clinic and the entire process can take up to a couple of hours.
There Are Many Side Effects Associated With Biologics. Apart from experiencing pain at the injection site, there are other side effects that you may also experience with biologics. These include.
- Swelling at the site of injection
- Redness at the site of injection
Risks Associated With Biologics. There are also several types of risks associated with taking biologic drugs. However, in most cases, the possible benefits of biologics often outweigh the risks. These include.
- These drugs reduce your ability to fight infections.
- There is a higher risk of developing lymphoma.
- Your liver is likely to be affected ultimately leading to liver damage. If you become jaundiced, you must immediately inform your doctor.
- You may develop joint pain similar to what happens in arthritis.
- You may experience fever, muscle ache, joint pain, and rashes, similar to a lupus-like reaction, or LLR.
You Will Need To Continue Taking Biologics. The fact is that even if you enter a remission stage, you will still need to continue taking biologics since they may not work as well as they are if you stop and then restart the medications again. This is so because your body can produce antibodies that render the biologic drugs ineffective or less effective. This is also one of the major reasons why doctors will recommend that you continue using biologics even when your Crohn’s is in a remission phase. Furthermore, biologics are effective at maintaining the remission stage by offering protection against flare triggers. However, there are certain situations when your doctor may recommend a break from taking the medication, for example, if you need to have surgery.
Complete Your Vaccination Schedule Before Beginning Biologics. Once you begin treating Crohn’s Disease with biologics, you will not be able to take live vaccinations such as MMR (measles, mumps, rubella), because there is a risk of infection present with such live vaccinations.
Weighing the Risks and Benefits of Biologics
Before prescribing biologic drugs, your doctor will weigh the potential risks looking at your individual condition against the benefits they hope you will achieve in the treatment of Crohn’s disease. Not all medical experts share the same thought on when is the best time to begin biologics for treating Crohn’s, but they do agree that biologics are the ideal treatment option for those who have severe Crohn’s disease that may cause permanent damage and may require surgery.
Doctors will generally look at the signs of disease progression, for example, exactly how long it has been between your diagnosis of Crohn’s and when you develop fistulas or breaks in the intestinal wall. The time period helps them determine which patients will perform better on biologics.
Doctors also check for any existing health problems, such as liver infection or tuberculosis. Once biologics are started, doctors continue to closely monitor you for signs of any potential side effects. This monitoring process involves diagnostic lab tests and regular skin checks for symptoms of skin cancer.
While some doctors prefer to use the ‘step-up therapy’, reserving the use of biologics only once the disease progresses beyond the mild to moderate stage, or when the standard Crohn’s medications do not work well for your condition. The preference for conventional drugs is perhaps due to the fact that doctors are aware of how they work and what to expect from these standard drugs. They also believe that using a biologic first will exhaust the treatment options at the beginning itself.
On the other hand, many doctors prefer to begin treating Crohn’s disease with biologics itself, in the hope of stopping the progression of the disease and delaying the need for surgery.
The prevailing thought amongst doctors, though, still remains that you should begin treatment with biologics sooner rather than later, especially if you are suffering from severe Crohn’s.
Biologic drugs have shown good progress in the treatment of Crohn’s disease. They work effectively by targeting and inhibiting the inflammation in the gut that is what triggers the flares in Crohn’s. However, there are several side effects associated with biologics, including a decreased ability to fight infection. Remember that you have to continue taking the biologic drugs even when you enter the remission stage unless your doctor recommends otherwise.
- Sands, B.E., Sandborn, W.J., Panaccione, R., O’Brien, C.D., Zhang, H., Johanns, J., Adedokun, O.J., Li, K., Peyrin-Biroulet, L., Van Der Woude, C.J. and Colombel, J.F., 2017. Ustekinumab as induction and maintenance therapy for Crohn’s disease. New England Journal of Medicine, 376(18), pp.1723-1736.
- Feagan, B.G., Sandborn, W.J., Gasink, C., Jacobstein, D., Lang, Y., Friedman, J.R., Blank, M.A., Johanns, J., Gao, L.L., Miao, Y. and Adedokun, O.J., 2016. Ustekinumab as induction and maintenance therapy for Crohn’s disease. New England Journal of Medicine, 375(20), pp.1946-1960.
- Rutgeerts, P., Sandborn, W.J., Feagan, B.G., Reinisch, W., Olson, A., Johanns, J., Travers, S., Rachmilewitz, D., Hanauer, S.B., Lichtenstein, G.R. and de Villiers, W.J.S., 2005. Infliximab for induction and maintenance therapy for ulcerative colitis. New England Journal of Medicine, 353(23), pp.2462-2476.
- Colombel, J.F., Sandborn, W.J., Reinisch, W., Mantzaris, G.J., Kornbluth, A., Rachmilewitz, D., Lichtiger, S., D’Haens, G., Diamond, R.H., Broussard, D.L. and Tang, K.L., 2010. Infliximab, azathioprine, or combination therapy for Crohn’s disease. New England Journal of Medicine, 362(15), pp.1383-1395.