Biologics for Crohn's Disease Treatment

Biologics are prescription drugs made from living organisms. Your doctor may prescribe one to you if other treatments haven’t worked.

Biologics work on your immune system. They target specific proteins in your body that cause inflammation.

The FDA has approved these biologics to treat Crohn’s disease:

  • Adalimumab (Humira)
  • Adalimumab-adbm (Cyltezo), a biosimilar to Humira
  • Adalimumab-atto (Amjevita), also a biosimilar to Humira
  • Certolizumab (Cimzia)
  • Infliximab (Remicade)
  • Infliximab-abda (Renflexis), a biosimilar to Remicade
  • Infliximab-dyyb (Inflectra), also a biosimilar to Remicade
  • Natalizumab (Tysabri)
  • Ustekinumab (Stelara)
  • Vedolizumab (Entyvio)

Adalimumab, adalimumab-adbm, adalimumab-atto, certolizumab, infliximab, infliximab-abda, and infliximab-dyyb work on a protein called TNF-alpha that's part of the inflammation process.

Natalizumab and vedolizumab work by stopping certain molecules in your immune system -- called integrins -- from attaching to other cells in the lining of your intestines.

Ustekinumab blocks the proteins interleukin 12 and 23, which are also part of the inflammation process.

Adalimumab (Humira), Adalimumab-adbm (Cyltezo), Adalimumab-atto (Amjevita)

These drugs may ease symptoms of moderate to severe Crohn’s disease. They may also help keep them from coming back.

How they’re given: You get a shot under your skin every 2 weeks.

What are common side effects?

  • Redness, swelling, itching, pain, rash, or bruising of the skin where you got the shot
  • Upper respiratory or sinus infections
  • Headache
  • Nausea

What are some other potential side effects? All biologics can have side effects, including infections like tuberculosis and sepsis. These drugs don't cause tuberculosis, but they may trigger it in people already exposed to it.

A few people have gotten cancers like lymphoma.

Certolizumab (Cimzia)

This drug also eases symptoms of moderate to severe Crohn’s disease and helps to keep them from returning.

How it’s given: A shot under your skin. The first three doses are given 2 weeks apart. Then maintenance doses are every 4 weeks.

What are the most common side effects?

What are other potential side effects? You may be more likely to get tuberculosis and sepsis.

Your odds of getting other infections may be higher than most. Tell your doctor right away if you have an infection, or if you have a cough, fever, fatigue, or the flu. In rare cases, people get cancers like lymphoma.

Continued

Infliximab (Remicade), Infliximab-abda (Renflexis), Infliximab-dyyb (Inflectra)

These drugs can lessen your symptoms. They may also help heal and lower your number of fistulas. These are abnormal connections between parts of your intestines, or from the intestines to your organs or skin. They often become infected and drain pus, mucus, or stool.

How they're given: Your doctor will give them to you through an IV. After your first dose, you'll get another IV dose at 2 weeks and 6 weeks. After that you'll get an IV dose every 8 weeks.

What are the most common side effects?

  • Redness, swelling, itching, pain, rash, or a bruise where the IV is given
  • Upper respiratory or sinus infections
  • Sore throat
  • Headache
  • Rash
  • Nausea
  • Coughing
  • Stomach pain

What are other potential side effects? Like with other biologics, there can be serious infections, such as tuberculosis and sepsis. It’s rare, but some people have gotten cancers like lymphoma.

Natalizumab (Tysabri)

Your doctor may recommend this drug if you have moderate to severe Crohn's disease with signs of inflammation. If you take it, you can’t use other biologics or drugs that block your immune system.

How it’s given: Your doctor will give it to you through an IV every four weeks.

What are the most common side effects?

  • Upper respiratory infections
  • Urinary tract infections
  • Headache
  • Depression
  • Fatigue
  • Diarrhea
  • Stomach pain
  • Rash

What are other potential side effects? This drug raises your odds of a rare but sometimes fatal brain infection called progressive multifocal leukoencephalopathy (PML). It can also cause allergic reactions and liver damage.

Ustekinumab (Stelara)

It’s used to treat moderate to severe Crohn’s disease.

How it’s given: Your doctor will give you the first dose through an IV. Then you’ll get a shot every 8 weeks.

What are the most common side effects?

  • Infections (urinary tract, yeast, upper respiratory)
  • Feeling tired
  • Headache
  • Itching
  • Redness where you got the shot

What are other potential side effects? Like other biologics, ustekinumab may raise your odds of getting a serious infection or sepsis. There’s also a chance of allergic reactions, serious lung inflammation, and certain types of cancer or nervous system disorders.

Continued

Vedolizumab (Entyvio)

It’s used to treat moderate to severe Crohn’s disease.

How it’s given: Your doctor will give it to you through an IV. After your first dose, you'll get another IV dose at 2 weeks and 6 weeks. After that you'll get a dose every 8 weeks.

What are the most common side effects?

  • Upper respiratory infections
  • Headache
  • Joint pain
  • Nausea
  • Fatigue
  • Fever
  • Rash
  • Pain in your hands and feet

What are other potential side effects? Like other biologics, vedolizumab may raise your odds of getting a serious infection like tuberculosis or sepsis. There’s also a chance of allergic reactions, liver damage, and a rare but sometimes fatal brain infection called PML.

Work Closely With Your Doctor

If your doctor prescribes a biologic, they’ll want to see you often to make sure the treatment works safely and effectively. So be sure to go to all of your appointments.

Tell your doctor about all prescription and over-the-counter drugs, supplements, or natural remedies you take. Any of those can affect the way other medications or supplements work. Talk to your doctor before you take anything new. Also tell your doctor about all of your medical conditions. Let them know if your symptoms get worse or if you notice any new ones.

Costs of Biologics

Biologic drugs, even generic or biosimilar versions, can be very expensive. They’re hard to make, and that drives up the price. One year of treatment can add up to about $20,000. Even if you have health insurance, you may have to pay 25% to 35% of the cost of the drug.

Many drug companies and private groups offer programs that provide drugs at low or no cost. These resources may help you or refer you to a group that can:

WebMD Medical Reference Reviewed by Neha Pathak, MD on October 15, 2020

Sources

SOURCES:

American College of Gastroenterology, Practice Guidelines: "Management of Crohn's Disease in Adults."

Amgen Prescribing Information, Amjevita.

Crohn's & Colitis Foundation: "Biologic Therapies," "Understanding IBD Medications and Side Effects," "Medications: Biologic Therapy," "About Crohn's Disease."

FDA: “FDA approves Amjevita, a biosimilar to Humira,” “FDA approves Inflectra, a biosimilar to Remicade,” "Prescribing Information, Infliximab-dyyb (Inflectra)," "Facts and Myths About Generic Drugs."

American Academy of Allergy Asthma & Immunology: "Medications and Drug Allergic Reactions: Tips to Remember."

Stelara Prescribing Information. Dryden Jr., G. Expert Opinion on Biological Therapy, August 2009.

Trapp, Doug. American Medical News, April 12, 2010.

Engelberg, A. New England Journal of Medicine, Nov. 12, 2009.

Society of Actuaries:  "Infliximab therapy for individuals with Crohn's disease: Analysis of health care utilization and expenditures."

Sensabaugh, S. Journal of Generic Medicines, 2007.

Forbes: "Why Biologics Remain Expensive."

© 2021 WebMD, LLC. All rights reserved.

Pagination