How Biologics Work
“The biologics that have been approved for Crohn’s and ulcerative colitis involve antibodies that are developed in the lab to target proteins related to inflammation,” says Joel Pekow, MD, a gastroenterologist and an associate professor of medicine at the University of Chicago.
The biologics that are now approved by the U.S. Food and Drug Administration (FDA) for treating ulcerative colitis include:
- adalimumab (Humira)
- golimumab (Simponi)
- infliximab (Remicade)
- vedolizumab (Entyvio)
- ustekinumab (Stelara)
- risankizumab (Skyrizi)
- guselkumab (Tremfya)
The Advantages of Biologics for Ulcerative Colitis
“Patients are often nervous about biologics,” says Laura Raffals, MD, a gastroenterologist at the Mayo Clinic in Rochester, Minnesota. “But they’re not as scared about taking a corticosteroid, and that’s an important conversation to have because the data shows that patients on biologics are much safer and stay in remission longer. The serious side effects we see are from steroids or narcotics, not biologics.”
The Potential Downsides of Biologics
While biologics may be a promising option for treating UC, not every drug is suited to every patient.
Dr. Raffals says, “We will work with patients for a while to tailor a treatment plan that is right for them. That may mean trying different biologics and small-molecule drugs,” such as upadacitinib (Rinvoq), tofacitinib (Xeljanz), or ozanimod (Zeposia). And of course, she adds, “taking into account what the patient’s insurance will cover.”
A person’s lifestyle, demographic factors such as age, other medical conditions such as a history of cancer or being immunocompromised, and the severity of the disease are all considerations in the choice of whether to use biologics and which is the best option.
Some potential downsides of taking biologics include:
- Lack of Long-Term Data While studies and clinical information indicate that biologics are generally safe, they are relatively newer drugs, so with the exception of Remicade, long-term safety information is scarce.
- Cost Because most of these drugs are available only as name brands, they can be very expensive. The introduction of biosimilars — medicines that are very similar to an original biologic therapy that is no longer patented — for Remicade and Humira has increased competition in the biologics market, with an aim to bring down the cost of this type of therapy.
- Method of Treatment Taking biologics isn’t as simple as swallowing a pill. Some biologics, such as Humira and Skyrizi, can be self-administered via an at-home injection, while others, like Entyvio, require intravenous infusion, though a new subcutaneous option is available as well for Entyvio. Your level of comfort or schedule may influence your choice between biologics or whether to take them at all.
- Side Effects As with all medications, biologics come with potential side effects. These include redness or itchiness at the injection site, increased susceptibility to infection, and a low increased risk of cancer.
If you’re considering biologics for treatment, speak to your doctor to find out what’s best for you. “At the heart of the decision is the relationship between the patient and the physician and specifically exploring what works best for each individual,” Tsynman says.
The Takeaway
- Biologics can help you better manage the symptoms of moderate to severe UC. They directly target factors that are responsible for the condition, unlike other medications that affect the whole body and have significant side effects.
- Biologics come with potential downsides, like the need for injections, high costs, and side effects such as increased susceptibility to infection.
- There are now many options that can be tailored to fit your needs. Discuss with your doctor which treatment best suits your health needs.