In the past, powerful anti-inflammatory medications called 5-aminosalicylates (5-ASAs) and corticosteroids have traditionally been the first go-to options for Crohn’s disease. However, these treatments don’t target the specific immune system pathway problems that lead to Crohn’s inflammation. That means they don’t always work well, and your symptoms could come back.
Biologics are a newer class of Crohn’s disease medications. They are genetically engineered medications made from the products of living organisms, including proteins, genes, and antibodies.
Biologics relieve Crohn’s disease symptoms by targeting specific proteins that increase or decrease inflammation. Biologics may help you enter and remain in remission without steroids.
This article discusses four signs it might be time to try biologics for Crohn’s disease.
1. You have just been diagnosed
Previously, biologics were often the last treatment to try. Doctors typically followed a “step-up” approach, meaning they first prescribed less expensive medications like steroids and went up from there.
However, prescribing biologics earlier may be helpful for people diagnosed with moderate to severe Crohn’s disease. These medications can induce mucosal healing, reducing inflammation in the inner lining of the digestive tract.
A 2019 review of several studies noted that achieving mucosal healing may:
- reduce the need for steroids
- decrease the risk of serious complications like intestinal ulcers
- reduce the need for hospitalization and surgery
2. The medications you’re taking aren’t helping you
For some people, medications like corticosteroids and 5-ASAs may stop working over time or may be ineffective.
In 2021, the American Gastroenterological Association released guidelines recommending biologics for people with moderate to severe Crohn’s disease that hasn’t gotten better using other medications.
3. You have complications called fistulas
Unmanaged inflammation due to Crohn’s disease can severely damage the GI tract. Many people with Crohn’s disease develop a complication called fistulas. These occur when intestinal ulcers caused by Crohn’s disease get larger, creating atypical connections between tissues and organs.
Biologics in the anti-tumor necrosis factor (TNF) class, such as infliximab (Remicade), are recommended as a treatment option for people experiencing fistulas caused by Crohn’s disease.
Learn more about common complications of Crohn’s disease.
4. You’re having surgery for Crohn’s disease
Many people with Crohn’s disease will need surgery due to complications. Some research suggests that prompt biologic treatment may lower the chance that the disease will recur after surgery. In the long term, biologics may reduce the risk of additional hospitalization and surgeries.
Learn more about Crohn’s disease surgery.
The Food and Drug Administration (FDA) has approved the following biologic medications for people with Crohn’s disease:
- infliximab (Remicade)
- vedolizumab (Entyvio)
- certolizumab (Cimzia)
- adalimumab (Humira)
- ustekinumab (Stelara)
- risankizumab-rzaa (Skyrizi)
The biologic you receive will vary depending on your situation.
Learn more about the classes of biologics for Crohn’s disease.
There is no one-size-treats-all therapy for Crohn’s disease. There are many types of biologics, and the one that works for you will depend on factors such as:
- the severity of your Crohn’s
- what other treatments you’ve tried
- whether you would prefer to receive your medication every few weeks or months
- whether you want to receive your medication by injection or intravenous (IV) infusion, meaning it will be administered through a vein
Because biologics influence your immune system, you must have a negative tuberculosis (TB) test before starting a biologic. Some people exposed to TB bacteria at some point in their lives have what is called a latent TB infection. This means the bacteria are dormant in their bodies, but they haven’t yet made them sick with TB disease.
The Crohn’s and Colitis Foundation notes that some biologics can activate the infection, potentially making you very sick. These medications may also activate the hepatitis B virus, so hepatitis testing will be necessary as well.
Biologics, like all medications, can also cause side effects. Common side effects of biologic treatments include:
- headache
- fever
- chills
- low blood pressure
- breathing difficulties
- hives
Always tell your doctor about any side effects you have during or after treatment.
Learn more about the benefits and risks of biologics for Crohn’s disease.
You may wish to talk with your doctor about biologics for Crohn’s disease if you’ve recently received a diagnosis, your treatment isn’t working, you’re experiencing complications, or you’ve recently had surgery. Biologics may help you enter and stay in remission and reduce the risk of future complications or surgeries.