Biologic medicines, also known as biologics, have been shown to be very safe and effective in people with inflammatory bowel disease (IBD). In fact, these drugs have become the standard of care for people with moderate to severe Crohn’s disease or ulcerative colitis.
At the IBD Center at the University of Chicago Medicine, we may recommend a biologic as part of your personalized treatment plan. Starting on these medications early in the course of your treatment can help you achieve remission and relief from your symptoms more quickly.
How Biologics Treat IBD
Biologic are used to treat IBD because they help the immune system target certain proteins that cause inflammation. They work by blocking chemical messages from the immune system that trigger a cascade of inflammatory events in people with IBD.
In both types of IBD, the body’s immune system attacks the gastrointestinal (GI) tract. Researchers believe the immune system is responding to normal bacteria and other organisms in the body that it perceives as threats. Biologics interrupt these attacks by mimicking proteins that the body naturally makes on its own to “turn down” the immune system.
Biologics are administered by infusion through an intravenous (IV) line or self-administered in the form of an injection.
Different Types of Biologics for IBD
Many classes of biologics are available to treat IBD, including:
- Tumor necrosis factor-alpha (TNF-alpha) blockers, which were the first class of biologics approved to treat IBD in the United States. They work by blocking a small protein that causes inflammation in the intestine. Examples of TNF-alpha blockers include Remicade® (infliximab), Humira® (adalimumab), Simponi® (golimumab) and Cimzia® (certolizumab pegol). These biologics also can help heal the intestine.
- Integrin blockers, which prevent white blood cells that cause inflammation from entering the GI tract. Entyvio® (vedolizumab) is approved in the United States for treating IBD. Tysabri® (natalizumab) is approved for patients with moderate to severe Crohn’s disease who do not respond to other types of therapy.
- Interleukin blockers, which target interleukin-12 and interleukin-23, two proteins associated with inflammation in the GI tract. An example is Stelara® (ustekinumab), which was first approved to treat dermatologic conditions and is now approved in the United States for treating IBD.
Biosimilars vs. Biologics for IBD
Biosimilars are also becoming available to treat IBD. Biosimilars could be thought of as “generic biologics,” although they are much more difficult to manufacture than a typical generic drug. Biosimilars of Remicade® (infliximab) are currently on the market and are sold under the names Avsola®, Inflectra® and Renflexis®. More biosimilars will become available in the future.
Biosimilars that are approved in the United States must meet very strict criteria so that they have the same safety and efficacy as the original biologic drug.
Choosing the Right Biologic for IBD
Your GI specialist will determine which biologic is right for you based on a number of factors. These include:
- Whether you have Crohn’s disease or ulcerative colitis
- The severity of your IBD
- Your medical history, including whether you have had previous infections or cancer
- Your age
- Whether you have fistulas, which are abnormal connections between parts of the body, and/or perianal disease
- Your ability to give yourself shots
- Your distance from an infusion center
- Your insurance plan and the financial assistance available to you from various drug companies
Within days or weeks of starting on a biologic, you may notice your symptoms becoming less severe. However, everyone is different, and some medicines may work more quickly than others. Your GI specialist may start with a smaller dose and gradually increase it until you notice its effects.
What is most important is finding the right medication for you over the long term so that you can have a lasting remission without IBD symptoms.
Switching Biologics During IBD Treatment
You and your GI specialist may decide to switch your biologic for several reasons. These include:
- If you are experiencing side effects from your medicine
- If you are not seeing any improvement even after increasing the dose
- If you are a woman trying to become pregnant because some biologics are better for pregnant women
At UChicago Medicine, we will closely monitor you for side effects and make sure you are on the best biologic for you. We recommend that you see our team at least every three months so that we can make a switch if needed.