What to Consider Before Starting a Biologic

Since being diagnosed with Crohn's disease in 2009, I have been on 7 different medications. I started with Pentasa, dabbled in Remicade, Humira, Cimzia, and Azathioprine, tried Stelara, and am now on Entyvio (and doing quite well). 

Each time I was faced with another medication failing to work, I had to make a decision as to what step to take next and what medication would be best for me. I also felt like when I was first put on a biologic (Remicade), I had some hesitancy – didn't these drugs cause cancer? How would they affect me long term? The list went on.

Should I go on a biologic for my IBD?

I often get questions in my personal and professional life from those who are faced with starting a biologic, mostly about what made me decide to start one along with the concern that they will be on a "lifetime medication" which doesn't always sit well with them.

Below is a list of things to consider before making your decision to start a biologic – whether it be for Crohn's, ulcerative colitis, or another IBD – that I hope are helpful during this overwhelming process:

Weigh risks vs. benefits of biologics

It is really easy to only see the risks before taking a biologic, especially when you hear the list of potential side effects during the commercial for the biologic you were prescribed. And that is totally understandable. However, it is important to weigh the risks versus the benefits when it comes to your disease. 

I remember talking about this with my GI before starting Remicade, concerned about the increased risk of getting lymphoma. He explained to me that increased risk means rather than having a 1 in 100,000 chance of getting it, it is now 2 in 100,000. Technically that is twice as risky, but is still a small risk compared to the benefits Remicade would provide. 

I was also more at risk of developing a complication from my disease that could be deadly rather than a complication from the medication itself. After weighing my risks and benefits, I knew that starting a biologic was the best choice for me.

Ask as many questions as necessary

Just as I asked my GI questions about the potential side effects and risks of starting a biologic, feel free to ask your provider as many questions as necessary in order for you to make a clear, educated decision

Maybe your questions are more around the convenience and cost of the medication, or how it may interfere with other medications you are currently taking. Whatever your concerns, be sure they are addressed in detail by your GI so that you are comfortable with whatever decision you choose.

Consider the source of your research

Doing research comes with its own set of risks and benefits. Yes, you can find real-life experiences from patients who have had taken the biologic and can share their story, but not all info shared may be accurate

There may be biases towards their experience, or maybe they made inaccurate assumptions about side effects that were not correlated to the medication. The point is, do your research, but also take it with a grain of salt.

Ultimately, your body is going to respond to a medication as it will, regardless of how others react, so do what is best for you and your disease. Each patient will have a unique treatment path.

Don't dwell on it as a life sentence

This is one of the biggest pushbacks I hear against starting a biologic: "But this means I have to be on it forever, right?" Well, maybe. 

But, until there is a cure, you will also have your disease forever, so rather than focusing on the fact that you may be on this medication for the rest of your life, think about the quality of your life while on it.  

Will the medication allow you to travel more freely, or eat without the worry of getting sick? Will it keep you out of the hospital and limit flares? Don't look at the length of time you may be on the medication, rather look at it as the length of time you will feel well should the medication work.

Deciding what is next in your Crohn's or colitis treatment journey

Obviously, there are many things to consider before starting a biologic and only you can be the ultimate decision-maker before starting it. The above are some tips to consider, especially when feeling overwhelmed at the the thought of starting something that shouldn't be taken lightly. 

Take your time, think it through, and also know that you can always course-correct down the road should it not work out as you had hoped.

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