8 Facts About Biologics for Crohn’s Disease
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Since biologic drugs first appeared as a treatment for Crohn’s disease and ulcerative colitis in the late '90s, they've continued to improve the lives of many people with these digestive diseases. Here are eight facts you should know about biologics and Crohn’s disease.
Fact: Biologic therapies have revolutionized the treatment of moderate to severe Crohn’s disease.
“Decades ago, Crohn’s disease was a debilitating disease that resulted in multiple surgeries for bowel resection, nutritional deficiencies, chronic pain, diarrhea, and psychological stress,” says Kumar Desai, MD, a gastroenterologist with Los Robles Hospital and Medical Center in Thousand Oaks, California. “Biologic medications have allowed people to live normal lives without complications like chronic diarrhea and malnutrition.”
Fact: Biologic drugs fight the underlying inflammation that fuels Crohn’s disease.
“Crohn’s disease takes the body’s natural response to infection and injury and attacks the colon,” Dr. Desai says. While no medication can cure Crohn’s disease, biologic medications do double duty by treating symptoms and helping heal active inflammation, says Robin Rothstein, MD, an associate professor of clinical medicine at Temple University School of Medicine in Philadelphia.
“The older and more common biologic drugs block an agent called tumor necrosis factor-alpha (TNF-alpha), and a newer agent blocks white blood cells that go to inflamed tissues. We now know it’s very important to heal the inflammation behind Crohn’s disease to prevent complications, such as strictures and abscesses,” Dr. Rothstein says.
Fact: Biologic drugs are more targeted and potentially more effective than other medications for Crohn’s disease.
Biologic medications offer an advantage over other Crohn's disease drugs because they can target a specific mechanism of inflammation. Corticosteroid drugs, on the other hand, suppress the entire immune system and produce side effects throughout the body.
“Biologics block specific processes within the inflammatory cascade,” says Arun Swaminath, MD, a gastroenterologist at Lenox Hill Hospital in New York City and an assistant professor at the Hofstra North Shore-LIJ School of Medicine in Hempstead, New York. They target particular proteins and enzymes proven to be too high or too low in people with inflammatory bowel disease such as Crohn’s disease.
Fact: Current biologic medications are given intravenously (IV) or by injection.
“We usually administer biologic drugs via IV infusion or injection under the skin," called subcutaneous injection, Dr. Swaminath says. Infusions take about one to two hours and are usually given at a hospital or clinic every four to eight weeks, depending on the medication. Biologics given as injections are usually self-administered at home every two to four weeks.
Fact: Using a combination approach to Crohn’s disease treatment that includes biologics may be more effective, especially early on.
“Biologic drugs can be given in combination or alone, depending on the person,” Desai says. They may be prescribed along with corticosteroid, immunomodulator, or topical anti-inflammatory medications.
In the landmark SONIC study published in the New England Journal of Medicine in 2010 and the most recent study of its kind, researchers compared Crohn’s disease treatment with immunomodulator drugs alone, the biologic drug infliximab alone, and the two drugs given together. The most benefits in terms of remission, mucosal healing, and reduced risk of infection were seen in the group who took the combination of biologic and immunomodulator drugs, followed by the group who only took a biologic drug, then those who only took an immunomodulator.
“Within a year of this study, doctors started more frequently prescribing the combination of biologic and immunomodulator medications for people with moderate to severe Crohn’s disease,” Swaminath says.
The findings of the SONIC study were confirmed in a review article published in February 2015 in the journal Gastroenterology Report, which pointed out not only the higher remission success when biologic and immunomodulator drugs were combined, but also that this approach lowered relapse rates. Studies have also found that rather than waiting to start biologic and immunomodulator medications, early treatment may be more effective, according to a review in the Journal of Gastrointestinal and Liver Diseases in 2012.
Fact: Biologic drugs have potentially serious side effects, but they should be considered in perspective.
“If you look at the prescriber information for biologic drugs, it will scare the pants off you," Swaminath says. "However, if you look at the prescriber information for acetaminophen, it will scare you, too. You have to keep in mind these are legal, not medical, documents."
The side effect of biologics that tends to cause the most concern is the increased risk of certain cancers, notably lymphoma. Because biologic drugs suppress the immune system, another potential side effect is an increased risk of infection, including pneumonia.
“I think some concerns are valid, but you also have to look at the benefits versus the risks,” Swaminath says. “Your risk of lymphoma may go from 1 in 10,000 to 3 in 10,000. But if you don’t take the biologic drug, you may put yourself at risk of flares, future complications and surgeries, and a decreased quality of life.”
Fact: Biologic medications must always be taken as directed, not as needed.
"Biologics are foreign proteins, so our bodies try to make antibodies against them,” Rothstein says. “Once these antibodies form, the medications become less effective. We’ve learned that using biologic medications on an intermittent basis increases the chances of developing antibodies and therefore makes the drugs less active.”
Fact: Open communication with your doctor is essential when considering and taking biologics for Crohn’s disease.
“It can be scary to need biologic medications, but these therapies can do wonders for people with moderate to severe Crohn’s disease,” Rothstein says. Talk to your doctor to better understand biologics and how to take them.
New biologic drugs are in development all the time and new guidelines for prescribing them continue to emerge. Staying in touch with your doctor can help you feel confident that you're taking the best medication for you.
Video: Case-based Discussion on Complicated Crohn’s Disease | UCLA Digestive Diseases
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