Inflammatory bowel disease (IBD), which includes Crohn’s disease (CD) and ulcerative colitis, is a condition caused by chronic inflammation of the digestive tract. While there is no cure for IBD, there are several types of medications that can be used to treat the disease by reducing inflammation, relieving symptoms, and helping the patient to enter and stay in remission. One of type of medication used to treat moderate-to-severe IBD is biologic therapy.1
What are biologic therapies?
Biologic therapies, or biologics, have been used in the treatment for IBD for the last several years.1-3 The active ingredients in biologic therapies are organic substances called antibodies that are engineered and grown in a laboratory. These engineered antibodies are made from living organisms. The antibodies in these medicines work in different ways to help to reduce inflammation in the body. They do so by targeting and affecting specific proteins and substances that are involved in the inflammatory process.
The inflammatory process is an important part of the body’s immune system. When the immune system senses the presence of an infection or other problem, it triggers the process of inflammation in order to fight off the infection. People with IBD have immune systems that cause too much inflammation in the digestive tract, and the chronic inflammation can damage the digestive tract and cause many different symptoms. Biologics work by specifically affecting this process of inflammation in order to reduce the amount of inflammation and help relieve a person’s symptoms.
What types of biologic therapies are used to treat people with inflammatory bowel disease?
Currently, there are three types of biologic therapies that are generally used to treat IBD:1,3
- Anti-tumor necrosis factor (anti-TNF) medicines
- Integrin receptor antagonist medicines
- Interleukin-12 and interleukin-23 inhibitors
Biologic therapies are a key area of focus in research in IBD, and new types of treatments are being designed and tested. It is likely that there will be more types of biologics available within the coming years.
Biologics can be very effective for some people with IBD, but they are also linked to some serious side effects. For this reason, biologics are usually recommended for patients with moderate or severe IBD who have tried treatment with aminosalicylates, antibiotics, corticosteroids, or immunomodulators, but:
- The medications did not work well enough for them
- The medications worked at the beginning, but do not work anymore
- They react badly to the medications
What are anti-tumor necrosis factor (anti-TNF) medicines?
Researchers have discovered a protein called tumor necrosis factor alpha (TNF-alpha) that is part of the process that causes inflammation in the intestines.1 Specific types of biologics called anti-tumor necrosis factor (anti-TNF) agents can seek out and then block the function of these TNF-alpha proteins, which has the effect of interrupting the inflammatory process.
For many people with IBD, this type of treatment can reduce inflammation and thus relieve the symptoms of IBD. This can help the patient to enter and stay in remission. In some cases, anti-TNF medicines can help to heal damage to the walls of the intestines that has been caused by chronic inflammation.
Biologic treatment does not work for all individuals with IBD, but many patients will experience benefits. In some cases, patients may notice immediate improvements right after starting the medication, but for others it may take up to 8 weeks before they experience an improvement in symptoms.
Common types of anti-TNF biologics used to treat patients with moderate-to-severe IBD are:
- Infliximab (brand name: Remicade)
- Renflexis, Inflectra, Avsola (Remicade biosimilars)
- Adalimumab (brand name: Humira)
- Certolizumab pegol (brand name: Cimzia)
- Golimumab (brand name: Simponi)
What are integrin receptor antagonists?
Integrin receptor antagonists are another type of biologic medicine.1 The antibodies in integrin receptor antagonists are designed to target and block certain functions of white blood cells, which are another important part of the body’s inflammatory process. The antibodies seek out and block a certain protein that is found on the surface of the white blood cells, which then prevents the white blood cells from traveling into the body’s tissues from the blood vessels. This is another way of interrupting the body’s inflammatory process, which can be overactive in people with IBD.
Common forms of integrin receptor antagonists used to treat people with IBD include:
What are interleukin-12 and interleukin-23 inhibitors?
Stelara (ustekinumab) was approved in 2016 for the treatment of Crohn’s disease. Ustekinumab is a monoclonal antibody that specifically targets interleukin 12 (IL-12) and interleukin 23 (IL-23). These interleukins are specific proteins that are involved in the inflammatory response, which is overactive in people with inflammatory bowel disease (IBD) like Crohn’s disease or ulcerative colitis.4
How are biologics administered?
Biologic therapies are usually administered either by injection (a shot) or by intravenous infusion (an IV).1 Sometimes patients are taught how to administer injections to themselves, and in other cases they receive injections from a healthcare provider or loved ones. IV infusions are generally delivered in an infusion center or a healthcare provider’s office. It can take anywhere from 30 minutes to several hours to deliver each dose of the infusion.
How frequently the patient receives each dose depends on the type of biologic therapy. However, in most cases, the patient starts off receiving a dose every 1-2 weeks which then tapers off to less frequent dosing.
What are risks associated with the use of biologics?
Patients often do not take biologics in combination with other types of drugs, such as immunomodulators, although in some cases it may be recommended.1,3 Combining therapies can sometimes increase their effectiveness, but it can also cause a higher risk of serious side effects.
Unlike some other forms of medicines used to treat IBD, biologics usually work specifically at the source of the problem, rather than affecting the entire body. Because they tend to have much less impact on the rest of the body, the side effects are often less severe. However, for a small number of people, treatment with biologics can have side effects that are very serious or even life-threatening. Healthcare providers will monitor patients carefully for any signs of these conditions.
The most common side effects are the development of redness, bruising, or itching at the site of injection. Biologics affect the immune system in a way that can make patients more susceptible to common or serious infections. If flu-like symptoms, including cough, fever, or chills, develop, patients should notify their healthcare providers immediately.1
This is not a complete list of side effects. It is important for patients to talk with healthcare providers about all potential treatment options and their side effects before choosing an IBD treatment. Patients should be sure to let their healthcare providers know about any and all medications or supplements that they are currently taking because some drug interactions can have dangerous side effects.
- Biologic Therapies. Crohn's & Colitis Foundation of America. Available at: http://www.ccfa.org/resources/biologic-therapies.html. Accessed 1/19/18.
- Brown SJ, Abreu MT. Biologic therapies in inflammatory bowel disease. Practical Gastroenterology 2005;July:38-63.
- Lowenberg M, D'Haens G. Next-generation therapeutics for IBD. Curr Gastroenterol Rep 2015;17:21. Simon EG, Ghosh S, Iacucci M, Moran GW. Ustekinumab for the treatment of Crohn's disease: can it find its niche? Therapeutic Advances in Gastroenterology. 2016;9(1):26-36. doi:10.1177/1756283X15618130.