As someone living with Crohn’s disease, you’ve likely heard about biologics and may have even thought about using them yourself. If something is holding you back, you’ve come to the right place. Here are six reasons you may want to reconsider this advanced type of treatment, and tips on how to do so.
1. You aren’t responding to traditional Crohn’s disease treatments
Perhaps you’ve been taking different Crohn’s disease medications, like steroids and immunomodulators, for a while now. However, you’re still having flare-ups several times a year.
The American College of Gastroenterology (ACG) guidelines recommend taking a biologic agent if you have moderate-to-severe Crohn’s disease that hasn’t improved using other drugs.
2. You’re newly diagnosed
Traditionally, treatment plans for Crohn’s disease involved a “step-up” approach. Less expensive drugs, like steroids, are tried first, while more expensive biologics are tried last. More recently, some doctors are advocating for a “top-down” approach to treatment, as evidence points to successful results with biologic treatments in newly diagnosed patients.
For example, one large study of medical claims data found that starting biologics early in the course of treatment for Crohn’s disease improves response to medication. The study group that began anti-TNF biologics early had significantly lower rates of needing steroids for treating flare-ups than the other study groups. They also had fewer surgeries due to Crohn’s disease.
3. You experience a complication known as fistulas
Fistulas are abnormal connections between body parts. In Crohn’s disease, a fistula can occur when an ulcer extends through your intestinal wall, which connects your intestine and skin, or your intestine and another organ. If a fistula becomes infected, it can be life-threatening. Biologics known as TNF inhibitors may be prescribed by your doctor if you have a fistula because they are so effective. The FDA has approved biologics specifically to treat fistulizing Crohn’s disease and to maintain fistula closure.
4. You want to maintain remission
Corticosteroids are known to bring out remission, but aren’t able to maintain that remission. Clinical studies show that anti-TNF biologics are able to maintain remission in patients with moderately severe Crohn’s disease. The ACG has determined that the benefits of these drugs to maintain remission outweigh the harms for most patients.
5. Dosing may only be once per month
The thought of an injection may be scary, but after the initial few doses, most biologics are administered only once per month. On top of this, the needle is very small, and the medication is injected just under your skin. Most biologics are also offered in the form of an auto-injector — this means you can get the injections without even seeing the needle. You can even give yourself certain biologics at home after you’re trained properly how to do so.
6. Biologics may have fewer side effects than steroids
Corticosteroids used to treat Crohn’s disease, such as prednisone or budesonide, work by suppressing the entire immune system. Biologics, on the other hand, work in a more selective way by targeting specific proteins in your immune system already proven to be associated with Crohn’s inflammation. For this reason, they have fewer side effects than corticosteroids.
Almost all drugs carry the risk of side effects. For biologics, the most common side effects are related to how they’re administered. You might experience minor irritation, redness, pain, or a reaction at the site of injection. There is also a slightly higher risk of infection, but the risk is not as high as other drugs, such as corticosteroids.
Overcoming your hesitation
The first biologic for Crohn’s disease was approved in 1998. So biologics have quite a bit of experience and safety testing to show for themselves. You may be hesitating to try a biologic treatment because you heard they were “strong” drugs or you’re afraid of the high costs.
While it’s true that biologics are considered a more aggressive treatment option, biologics are also more targeted drugs, and they work very well. Unlike some older treatments for Crohn’s disease that weaken the whole immune system, biologic drugs target specific inflammatory proteins known to be involved in Crohn’s disease. In contrast, corticosteroid drugs repress your entire immune system.
Understanding why biologics are the next step in your treatment plan can give you a better perspective on your condition. Your doctor might recommend biologics because you aren’t responding to other treatments. Or it may be because they may want to reduce your need for corticosteroids, which carry the risk of potentially serious side effects.
Choosing a biologic
Before biologics, there were few treatment options aside from surgery for people with severe Crohn’s disease. Now there are several options.
- adalimumab (Humira, Exemptia)
- certolizumab pegol (Cimzia)
- infliximab (Remicade, Remsima, Inflectra)
- natalizumab (Tysabri)
- vedolizumab (Entyvio)
You’ll have to work with your insurance company to find out if a particular biologic is covered under your plan.
It’s clear that biologic medications have improved the landscape of possibilities for treating Crohn’s disease and other autoimmune problems. Research continues to grow on biologics, making it likely that even more treatment options may be available in the future. Ultimately, your treatment plan is a decision best made with your doctor.Read more in Crohn's Disease Resources