Should I Take a Biologic? If So, When? continued...
Most doctors agree that biologics should be started sooner rather than later for people with severe disease or with factors that indicate Crohn's likely will be severe.
"I think the challenge in Crohn's disease today is to identify people who are going to have an aggressive disease course in the future and would benefit from biologic therapy now," says Bloomfeld.
Factors doctors may consider when predicting whether Crohn's is severe enough to need a biologic -- or might become severe -- include:
- Age at diagnosis. People who are diagnosed with Crohn's when they are young tend to have more severe disease.
- Involvement of the small intestine. About 70% of Crohn's cases involve both the small and large intestine or small intestine only.
- Need for corticosteroids. If you often need corticosteroids to control inflammation, you may be a candidate for a biologic therapy.
- Smoking. Smokers generally have more severe disease than nonsmokers.
- Fistulzing disease. Biologics may help heal fistulas, which happen when ulcers tunnel through two organs or parts of the body, such as two parts of the intestine.
Which Biologic Is Right for You?
When deciding on a biologic for Crohn's, doctors usually start with one of the TNF-inhibitors, says Bloomfeld. Tysabri is usually reserved for people who have failed anti-TNF therapy.
The TNF inhibitors have never been compared head-to-head in a study, so the decision to choose one over the other is largely about which one you and your doctor prefer.
How often you take the medication and how it's given may be factors in your decision. For example, two of the anti-TNF drugs, Humira and Cimzia, are given by injection -- Humira every two weeks; Cimzia every four weeks. Remicade is usually given every two months in two- to three-hour infusions at a doctor's office or infusion center.
Some people enjoy the convenience of the shot, says Prabhakar Swaroop, MD, assistant professor and director of the Inflammatory Bowel Disease Program at the University of Texas Southwestern Medical Center. "You can carry it with you and give it to yourself," he says. Others don't want to give themselves shots or just prefer to have an infusion administered in a medical setting.
Questions to Ask Your Doctor
Like all drugs, biologics have risks, and once you begin one, you will likely be on it for a long time. To determine if a biologic -- and if so, which one -- is right for you, ask your doctor the following questions:
- How is the drug administered? Will I need to go for infusions or can I give it to myself?
- Will this be the only treatment I need, or will I still have to take another drug along with it?
- How often will I need to have infusions or shots?
- Where would the infusion be given?
- Are there any adverse reactions that might occur with shots or during infusions? If so, how are they treated?
- What is the risk of side effects from the biologic? How does that compare with the risks of other treatments?
- What benefits should I expect? How do those compare with the other options?
- Is there a particular biologic that you have had experience or success with?