Biologic therapies can help Crohn’s enter remission by reducing symptoms and healing damage to the intestines due to inflammation.
Remission is the primary goal for people with Crohn’s disease.
Doctors usually prescribe biologic therapies to people with more severe Crohn’s symptoms who haven’t found relief with other methods.
Guidelines now recommend that doctors prescribe biologics for people with significant disease as a first-line approach, too.
Biologic therapies work by blocking certain chemicals that cause inflammation in your intestines.
Most biologics for Crohn’s disease block a protein called tumor necrosis factor (TNF).
The three anti-TNF biologics are:
Many people benefit from these medications, seeing an improvement immediately or anywhere up to 8 weeks.
Other biologics, such as Tysabri and Entyvio, block proteins called integrins that are involved in inflammation.
Some biologics act on other proteins involved in the immune system known as interleukins. Common targets include interleukin-23 (IL-23) and interleukin-12 (IL-12).
Humira is an anti-TNF treatment that you can administer yourself following a demonstration by a healthcare professional.
If your doctor decides you can administer the injections yourself, they’ll give you a set of pens with dosage-controlled medication inside.
You’ll also be given instructions on how many injections to take for the first 30 days. After the initial 30-day period, you will typically use one Humira pen every 2 weeks.
Remicade is a TNF-blocker that may help you better manage flare-ups. It may also help maintain remission to prevent symptoms from returning.
Remicade is given directly into the bloodstream, which 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.
You do not need to take Remicade every day. After 3 starter doses you may start to feel better, though some people may see benefits earlier. You’ll then have infusions every 8 weeks.
However, you cannot take this drug at home and must receive Remicade intravenously in a medical facility. Infusions are given over a minimum of a 2-hour period.
A doctor administers Cimzia, a TNF-blocker, via a small injection in their office or at your home.
If you choose to get the treatment in your doctor’s office, you have the option of receiving it in powder form. The powder is mixed with sterile water and then injected.
Another option is to use prefilled syringes. The syringes contain medication that’s already mixed in measured doses. You can use these at home or in a doctor’s office.
If you choose to self-administer, you’ll get a package with two syringes and instructions on giving the treatment.
After the first three doses, given every 2 weeks, you take Cimzia once every 4 weeks.
Tysabri prevents inflammation-causing white blood cells from entering tissues by blocking a protein on the surface of these cells called integrin.
Doctors give you Tysabri intravenously every 4 weeks. It takes about an hour to receive the full dose.
A doctor usually observes you for an hour afterward. Doctors typically give Tysabri to people who haven’t responded well or are intolerant to TNF blockers, immunomodulators, or corticosteroids.
If you have Crohn’s and are considering Tysabri, you should be aware of a very serious side effect.
If you’re taking Tysabri, you have an increased risk for a rare brain disease called
Healthcare professionals who prescribe Tysabri for Crohn’s will warn you of this risk. They’ll also explain how to enroll in a prescribing program called TOUCH. This program is the only way you can receive Tysabri.
Entyvio is another integrin blocker that is approved to treat moderate to severe Crohn’s disease in adults who haven’t responded well to, are intolerant of, or can’t take a TNF blocker, immunomodulator, or corticosteroid.
It works similarly to Tysabri, acting on certain white blood cells to prevent them from causing the bowel inflammation associated with Crohn’s.
Entyvio, however, is gut-specific and doesn’t appear to have the same risk of PML.
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 in week 2, week 6. After this, you’ll have an infusion every 8 weeks.
If no improvement in Crohn’s disease symptoms occurs by week 14, Entyvio therapy should be discontinued. Prior to starting Entyvio, make sure you’re up to date on your immunizations.
The third class of biologics is the IL-12 and IL-23 agonists.
Stelara is the drug in this class approved for treating adults with moderate to severe Crohn’s who haven’t responded well enough to conventional therapy.
The drug targets specific proteins that play a key role in the inflammation process.
Stelara is initially given intravenously under the supervision of a healthcare professional.
After this, doses can be given via an injection under the skin every 8 weeks by a healthcare professional or by yourself after you’re trained.
Guselkumab (Tremfya) is the most recent drug to be approved for Crohn’s and is the first IL-23 that can be given subcutaneously or intravenously.
It has dual action and works by blocking IL-23 and binding to CD64.
Although the benefits often outweigh the risks, biologic therapies can have serious side effects. Biologic therapy reduces the body’s ability to fight infections.
This can mean you are more susceptible to tuberculosis and other infections, including brain infections.
There’s also an increased chance of certain types of cancer in those taking biologics, especially in younger people. This can include hepatosplenic T-cell lymphoma, which is often fatal.
Some common side effects of biologics include:
- redness or other color changes, pain, itching, or swelling around the injection site
- low blood pressure
- hives or rash
- stomach pain
- headache
- fever or chills
- nausea
- cough or sore throat
- difficulty breathing
- back pain
Biologics may not be safe for everyone. Talk with your doctor about considerations if you:
- have tuberculosis
- have a heart condition
- are prone to infections
Tuberculosis
TB is a serious, infectious lung disease. If you use biologics for treating Crohn’s disease, it may increase the risk of reactivating a dormant TB infection if you had previous exposure to the bacteria.
Your doctor should test you for TB before starting any Crohn’s therapy with a biologic. Some people who’ve been exposed to the disease might not know it. Your doctor may recommend TB treatment before taking a biologic.
Infections
Biologics can reduce your ability to fight infection, so your doctor may suggest a different type of therapy if you’re more susceptible to infections.
Heart conditions
Anti-TNF medications may also be associated with certain heart conditions. This includes heart failure, which is when your heart can’t pump enough blood to your body.
Tell your doctor as soon as possible if you experience swelling of your feet or shortness of breath while taking a biologic for Crohn’s disease. These could be signs of heart failure, and you may need immediate medical attention.
Other issues
Biologic therapies may have links with other serious health problems. People taking biologics have sometimes reported the following health problems, though these are rare:
- lymphoma
- certain blood disorders (bleeding, bruising)
- severe allergic reactions
- liver damage
- neurological problems, including numbness, weakness, tingling, or visual disturbances, such as blurred vision, double vision, or partial blindness
Biologics offer an advantage in treating Crohn’s disease because these drugs specifically target the substances in your body that cause bowel inflammation.
Your doctor can discuss all the options, their benefits, and risks, and help you find the most suitable therapy for you.
In some cases, “biosimilars,” which are generic versions of biologic drugs, may be available. They can help manage your Crohn’s disease and are also cheaper. Your doctor can tell you if this is a better option for you.