If other treatments haven’t worked for you, biologics may be worth considering for managing Crohn’s disease.
As someone living with Crohn’s disease, you’ve likely heard about biologics, a prescription drug administered via an injection or intravenous (IV) drip that manages inflammation by blocking certain proteins or chemical pathways.
You may have also considered trying them yourself. If something is holding you back, here are six reasons you may want to reconsider this advanced type of treatment and tips on how to do so.
Perhaps you’ve been taking different Crohn’s disease medications, such as steroids and immunomodulators, for a while now. However, you’re still having flare-ups several times a year.
American College of Gastroenterology guidelines strongly recommend taking a biologic agent if you have moderate to severe Crohn’s disease that’s resistant to steroids or immunomodulatory therapy.
Your doctor may also consider combining a biologic with an immunomodulator, even if you haven’t tried those drugs separately yet.
Traditionally, treatment plans for Crohn’s disease involved a step-up approach. Less expensive drugs, like steroids, were tried first, while more expensive biologics were tried last.
More recently, guidelines advocate for a top-down approach to treatment, as evidence has pointed to successful results with biologic treatments in newly diagnosed cases.
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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. If you have a fistula, your doctor may prescribe biologics known as TNF inhibitors because they’re so effective.
The Food and Drug Administration (FDA) has approved biologics specifically to treat Crohn’s disease with fistulas and to maintain fistula closure.
Corticosteroids are known to bring about remission but aren’t able to maintain that remission. If you’ve been taking steroids for 3 months or longer, your doctor may start you on a biologic instead.
Clinical studies show that anti-TNF biologics are able to maintain remission in people with moderately severe Crohn’s disease.
Researchers concluded that the benefits of these drugs in maintaining remission outweigh the harms for most people.
The thought of an injection may be scary, but after the initial few doses, most biologics are administered only once per month. 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, which means you can get the injections without seeing the needle. You can even give yourself certain biologics at home after you’re trained properly on how to do so.
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’s also a slightly higher risk of infection, but the risk is not as high as other drugs, such as corticosteroids.
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 hesitant to try a biologic because you heard they were “strong” drugs or you’re concerned about the high costs.
While biologics are considered a more aggressive treatment option, they’re 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.
Before biologics, there were few treatment options aside from surgery for people with severe Crohn’s disease. Now, there are several options:
You’ll have to work with your insurance company to find out whether a particular biologic is covered under your plan.
Biologic medications have improved the possibilities for treating Crohn’s disease and other autoimmune conditions.
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.