Taking a Biologic for Crohn's Disease: Risks and Benefits
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:
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.
Swaroop says he looks for signs that the disease is progressing, such as how long between a person's diagnosis of Crohn's and when they have fistulas (breaks in the intestinal wall). "These are the patients who generally do better on biologics, who have the quality of life improvement, who are able to avoid surgery and get back in the workforce."
Before prescribing biologics, doctors check for potential problems. "In the beginning, of course, we go ahead and make sure the person does not have an active liver infection or TB," says Marie Borum, MD. She is a professor of medicine and director of the division of gastroenterology and liver diseases at George Washington University in Washington, D.C.
Once someone starts a biologic, the doctor looks for side effects in order to find them before they become serious. This monitoring includes lab tests and possibly regular skin checks for signs of skin cancer.