Remission is the primary goal for people with Crohn’s disease, but biologic therapies can provide a level of comfort. Biologic therapies work by blocking a condition called tumor necrosis factor (TNF). This condition causes the immune system to produce high amounts of protein. This in turn causes inflammation. By blocking TNF, biologic therapies prevent inflammation in the intestines.
However, 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. There’s also an increased chance of certain types of cancer in patients taking TNF blockers, especially in younger patients. One such cancer that could result is called hepatosplenic T-cell lymphoma. This type of cancer is often fatal.
Biologic therapies are usually prescribed in people with more severe Crohn’s symptoms who haven’t found relied with other methods.
Biologic therapies may be a great treatment option for people with Crohn’s. However, patients should weigh the risks of TNF blockers against the benefits. Generally, biologic therapies are only used after less invasive treatments have been attempted.
Biologic therapies for Crohn’s disease come in several brand names, each with varied dosage. These therapies include:
Remicade may help patients gain control of flare-ups. It may also help maintain remission to prevent symptoms from returning.
Remicade is given directly into the bloodstream. This 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 patient often sees benefits in as few as six doses per year. The downside is that Remicade must be given intravenously in a medical facility over a two-hour period.
Humira is a self-administered treatment following an initial demonstration by a healthcare professional. If your doctor decides you can handle the injections yourself, they’ll give you a set of pens with dosage-controlled medicine inside. You’ll also be given instructions on how many injections to take for the first thirty days. After the initial thirty-day period, patients typically use one Humira pen every two weeks.
Cimzia is the only biologic treatment for Crohn’s disease that uses an antibody that fights TNF. The antibody is called certolizumab pegol.
Cimzia is administered by a small injection. The injection can either be given in a doctor’s office or at home. If you choose to receive treatment in a 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 pre-filled syringes. The syringes contain medicine that’s already mixed in measured doses. The syringes can be administered 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 initial three doses, you will be able to take Cimzia every four weeks.
After several clinical trials, Cimzia was approved by the U.S. Food and Drug Administration (FDA) in 2008 for Crohn’s treatment. The trials showed Cimzia was effective in battling many of the symptoms of Crohn’s. These symptoms include diarrhea and stomach pain. Cimzia was also effective in restoring a sense of well-being within several weeks. Additionally, studies showed a sustained improvement in people with Crohn’s a few years later, without any increase in dosage.
Tysabri is given intravenously every four weeks. The process takes approximately one hour. Patients are usually observed for an hour afterward. Tysabri isn’t a TNF inhibitor and will usually not be prescribed until all other forms of treatment have been exhausted. Tysabri binds together certain white blood cells to prevent them from causing inflammation.
Crohn’s patients considering Tysabri should be aware of a very serious side effect. The FDA approved the drug in 2008 with an added warning about the risk of a rare brain disease called progressive multifocal leukoencephalopathy (PML). Any physician who prescribes Tysabri for Crohn’s will warn patients of those risks. They will also explain how to enroll in an outreach program called CD Touch (Crohn’s Disease Tysabri Outreach Unified Commitment to Health).
Entyvio was approved by the FDA in 2014 to treat adults with moderate to severe Crohn’s disease who haven’t responded well to or are intolerant of a TNF blocker, immunomodulator, or corticosteroid. Entyvio is a humanized monoclonal antibody. It prevents T-lymphocytes from moving into the inflamed tissues in the intestines. This reduces the bowel inflammation associated with Crohn’s disease.
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 two, on week six, and every eight weeks thereafter. If no improvement in Crohn’s disease symptoms occurs by week 14, Entyvio therapy should be discontinued. Prior to starting Entyvio, all patients should be up-to-date on their immunizations.Read more in Crohn's Disease Resources