Should I Be Taking Biologics When I Have an Infection?

Disclaimer: I am not a medical professional and my point of view reflects what rheumatologists and gastroenterologists have advised me in the past, in addition to reliable, scholarly resources. Always consult your prescribing doctor to come up with a plan and a follow-up.

Skipping biologic due to infection

There have been quite a few times over the 17-year course of living with IBD, specifically Crohn’s disease, that I’ve had to skip my biologic (one type or another) due to infection. This was of course under the guidance of my doctor. And typically this affects the stability of my medications –I definitely noticed more flare-ups with missing some biologics more than others I’ve been on.

This year was unprecedented for me. I lived in the hospital and in observation rooms almost more than I was actually sleeping under my own roof in my own bed. Due to the nature of many different illnesses and setbacks during the year, I still have yet to be on schedule for any dose of my biologic due to the severity of infections and the fragility of my state of health.

Unstable IBD with missed biologics

It’s definitely affected me in many ways and I can’t wait until I become more stable and can return to my regular scheduled every 8-week injection. According to Canada's Arthritis Society: "If you have to take antibiotics for an infection, you must temporarily stop taking your biologic until the infection is resolved. Your doctor will let you know when to resume your biologic treatment."¹

Of course, this will be coordinated by your medication provider when you notify them or they receive your results, if and when you should hold your biologics, and when to resume.

It’s frustrating because, on one hand, you know the WHY of the reasons you’re not able to be able to administer a biologic with an active infection, but you also just wait for the other foot to drop and suddenly be in a flare that cannot be reversed due to damage that can quickly occur in unmedicated IBD patients.

When my doctors have advised to pause injections

Doctors I’ve been to have always asked me to stop before surgeries and during active infections like strep, especially because strep tends to quickly enter my kidneys and I will quickly be even sicker. According to a 2019 surgery study: "The risk of flare and its association with the probability of infection or delayed wound healing should be considered."²

For example, one of the infections that patients are encouraged to hold biologics for is COVID-19. The severity of the infections may be a determining factor on which biologics are held – if that is the case.³

When my immune system has been compromised with certain infections, it’s not always safe to continue my biologic therapy (depending on the type) due to my already-weakened immune system. In these instances, stopping or holding the biologic until antibiotics have been finished and the infection has made its way out of my body was important.

Surgery complications, infection risks

Also according to the 2019 surgery study: "Although the use of biologic therapy is beneficial in patients with autoimmune diseases, surgery is an inevitable part of the treatment process of these patients. Some studies showed that the use of biologic agents could bring about some complications in patients undergoing surgery." This scholarly article also has a very helpful chart that goes into a comparison of some of the different types/names of biologics and time recommended for holding due to surgeries, depending on the type of biologic.²

What kind of experiences have you had with infections, including different types of severities? What was the ultimate determining factor that you and your doctor decided to do in response to the infection? Share in the comments below.