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Taking a Biologic for Crohn's Disease: Risks and Benefits

By Mary Anne Dunkin
WebMD Feature

Biologics are a class of drugs that can relieve your Crohn's symptoms and keep you in remission. Your doctor may prescribe them if you have moderate to severe Crohn's that doesn't respond to other treatments. As with all drugs, you need to weigh the risks and benefits.

Biologics and Side Effects

Because they suppress the immune system, all biologics carry an increased risk of infections, which in rare cases can be serious. Four biologics are approved by the FDA to treat Crohn's:

  • Cimzia (certolizumab)
  • Humira (adalimumab)
  • Remicade (infliximab)
  • Tysabri (natalizumab)

Cimzia, Humira, and Remicade carry a boxed warning for increased risk of serious infections that could lead to hospitalization or death. If someone taking a biologic develops a serious infection, the drug should be discontinued. People with tuberculosis, heart failure, or multiple sclerosis should not take biologics, because they can make those conditions worse.

Cimzia, Humira, and Remicade are a type of drug called a TNF inhibitor. In rare cases, some people taking TNF inhibitors have developed certain cancers such as lymphoma.

Tysabri increases the risk of a very rare but potentially fatal brain infection called progressive multifocal leukoencephalopathy (PML). Tysabri also can cause allergic reactions and liver damage. It should not be used at the same time as other treatments that suppress the immune system or TNF inhibitors.

Most infections that occur with biologic use are far less serious, though, says Richard Bloomfeld, MD. He is an associate professor of medicine and director of the inflammatory bowel disease program at Wake Forest University School of Medicine. "Infections such as colds, upper respiratory tract infections, and urinary tract infections are common and don't necessarily alter our treatment of Crohn's," he says.

Other common side effects from biologic use include:

  • Headache
  • Flu-like symptoms
  • Nausea
  • Rash
  • Injection site pain
  • Infusion reactions

Risks From Conventional Treatment

While there are other treatments that suppress the immune system to treat Crohn's, they too have side effects, Bloomfeld says. Like the biologics, drugs that suppress the immune system increase the risk of lymphomas and infections, which can be severe.

Corticosteroids like prednisone, for example, can cause a wide range of adverse effects, including:

  • Weight gain
  • Mood swings
  • Bone loss
  • Skin bruising
  • High blood pressure
  • High blood sugar

Those side effects are why corticosteroids may be used to control a flare, but aren't the choice to treat Crohn's over a long period of time.

"The stop-gap method, which is steroids, is something we cannot use long term," says Prabhakar Swaroop, MD. He is an assistant professor and director of the inflammatory bowel disease program at the University of Texas Southwestern Medical Center in Dallas.

Biologics: Weighing the Risks and Benefits

When prescribing any drug, doctors look at the potential risks against the benefits they hope to achieve. Although all doctors don't share the same philosophy on when to start biologics for Crohn's disease, they do agree that biologics should be used when people have severe disease that can lead to permanent damage that may require surgery.

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