Treating Crohn’s: Choosing the Right Biologic

From the WebMD Archives

If your doctor has talked about using biologic drugs to treat your Crohn's disease, you want to learn as much as you can about them. This guide to biologics includes some questions to ask your doctor and yourself. Use it to help you choose the treatment that's right for you.

What Are Biologics?

Unlike some Crohn's drugs, which suppress your whole immune system, biologics are antibodies that target particular proteins and cells and then block the process that causes inflammation in your gut. So you can get relief while avoiding some of the big side effects of other drugs.

Cimzia (certolizumab pegol), Humira (adalimumab), and Remicade (infliximab) are called anti-TNF-alpha antibodies because they block a protein called tumor necrosis factor-alpha.

Tysabri (natalizumab) prevents white blood cells from traveling to the inflamed gut area and causing more damage.

Should You Take a Biologic?

It depends largely on:

  • How severe your Crohn's is
  • What other treatments you've tried
  • Your doctor's treatment approach
  • What you prefer

When to Take a Biologic -- Sooner or Later?

Some doctors use "step-up therapy." They suggest a biologic only if you have moderate to severe active disease, and standard Crohn's drugs have not worked well for you.

Why use standard drugs first? "We know how they work, what to expect, and because of our comfort level with them, we tend to use them first," says Marie Borum, MD, professor of medicine and director of gastroenterology and liver diseases at George Washington University in Washington, DC. If you use a biologic early, she adds, you exhaust your treatment options up front.

Others doctors prefer to prescribe biologics from the start. "The trend is to use biologics early, with the hope of altering the history of disease," says Richard Bloomfeld, MD, associate professor of medicine and director of the inflammatory bowel disease clinic at Wake Forest University School of Medicine in Winston-Salem, NC. You may be able to avoid taking steroids that can have many serious side effects. And you may be able to avoid complications and delay the need for surgery.

Most doctors agree that people should start biologics sooner rather than later if they have severe Crohn's. Your doctor may suggest one if:

  • You were young when you got Crohn's
  • Your small intestine is involved
  • You use steroids often to control symptoms
  • You smoke
  • Ulcers have made "fistulas," which are passages through two organs or parts of your body, like two parts of your intestine

Continued

Which Biologic Is Right for You?

Most doctors choose anti-TNF biologics to start, Bloomfeld says. Tysabri is usually reserved for people who have not had a good response to these drugs.

When you choose a biologic, weigh how you'll need to get it -- and how often. For example, you get a Humira or Cimzia shot every two or four weeks. You take Remicade by IV every two months. Each IV session takes 2 to 3 hours at a doctor's office or IV center.

You might prefer the ease of a shot, which you can give yourself. On the other hand, you might prefer to get an IV in a medical setting, from a person trained to give it.

Questions to Ask Your Doctor

Like all drugs, biologics have pros and cons. Before you choose one, ask your doctor:

  • How is the drug given? Will I need IVs, or can I give it to myself?
  • Is this the only treatment I need, or will I have to take another drug along with it?
  • How often will I need to take the drug?
  • Where will I get IVs?
  • Could I have a bad reaction? If so, how is it treated?
  • How likely are side effects? How does that compare with other treatments?
  • What are the pluses of taking a biologic? How do those compare with other options?
  • Which biologic have you had the most success with?

You'll also want to ask yourself questions such as:

  • Am I OK with giving myself shots? Is there someone who can give them to me if I have trouble?
  • Can I commit to giving myself shots on schedule for a long time?
  • Can I sit still for 2 or more hours for an IV? Can I take the time away from my work or family?

Weighing the Risks and Benefits

You'll need to consider possible side effects and risks with biologics along with the benefits. For example, your skin could get irritated at the area of the shot or IV. There are also increased risks of cytopenia (decrease in some types of blood cells) and infection. And there have been reports of neurologic disease, congestive heart failure, lung fibrosis, liver toxicity, skin reactions, and possible increased risk of cancer. Talk to your doctor about these rare but potential risks.

WebMD Feature Reviewed by Arefa Cassoobhoy, MD, MPH on December 03, 2013

Sources

SOURCES:

Crohn's & Colitis Foundation of America: "Biologic Therapies."

Marie Borum, MD, professor of medicine, director of the Division of Gastroenterology and Liver Diseases, George Washington University,  Washington, DC.

Richard Bloomfeld, MD, associate professor of medicine, director of the Inflammatory Bowel Disease Clinic, Wake Forest University School of Medicine, Winston-Salem, NC.

Prabhakar Swaroop, MD, assistant professor and director, Crohn's and Colitis Program, University of Texas Southwestern Medical Center, Dallas.

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