How Effective Are Biologics for Inflammatory Bowel Disease?

Biologic medications have improved the outcomes for many people living with Crohn’s disease and ulcerative colitis. However, treatment plans may need adjustments over time.

Suppose you’re one of nearly 721 per 100,000 people in the United States living with inflammatory bowel disease (IBD), including Crohn’s disease and ulcerative colitis. In that case, you may know that long-term digestive tract inflammation can cause uncomfortable symptoms like abdominal pain, diarrhea, rectal bleeding, and fatigue.

Some IBD cases can be mild, while others may affect certain daily activities.

Though there’s currently no cure for IBD, several treatments are available that can help you feel better and reduce the inflammation. Newer therapies called biologics may be a safe and effective treatment option for many people with moderate to severe IBD.

What are biologics?

When you think of a drug, you may think of a traditional pharmaceutical medication created through a combination of specific chemicals. Biologics, on the other hand, are manufactured from natural, living sources. Doctors can typically give these as an injection or an infusion into a vein.  

Biologics target certain proteins in your body. These proteins can alter specific parts of your immune response, leading to inflammation. Unlike some drugs like corticosteroids, which affect your entire body, biologics act much more precisely on the source of inflammation.

What biologics are used for IBD?

There are a few classes of biologics that target proteins involved in IBD. These include:

• Tumor necrosis factor (TNF) inhibitors: Adalimumab (Humira) and infliximab (Remicade) are two examples of anti-TNF medication. They work by blocking tumor necrosis factor, a protein that causes inflammation in the intestine.
• Integrin inhibitors: This medication blocks a protein called integrin on your white blood cells. This prevents your white blood cells from entering your intestine and causing inflammation. Vedolizumab (Entyvio) and natalizumab (Tysabri) fall into this category.
• Interleukin inhibitors: Interleukin 12 and 23 are proteins that promote inflammation in your immune system. Ustekinumab (Stelara) and risankizumab (Skyrizi) stop the effects of these proteins, reducing IBD symptoms.

Are you a candidate for a biologic for IBD?

IBD often has a cyclic nature. You may experience periodic flare-ups, followed by times of remission in which symptoms resolve. IBD treatment aims to help you enter remission, stay in remission, and allow your intestine lining to heal.

Sometimes, conventional IBD treatments are effective. These include corticosteroids, aminosalicylates like sulfasalazine, and immunosuppressants like methotrexate. If these medications don’t work for you or if you experience corticosteroid dependence, a biologic therapy may be a better option for you.

A 2019 research review suggested that starting biologics, particularly TNF-inhibitors, earlier in the course of IBD may lead to improved outcomes and less permanent damage to your intestines. Talk with your doctor about whether this may be appropriate in your case.  

Which biologic will work best for you?

With an increasing number of available biologics, you may wonder which one may be most effective. Few studies are available directly comparing biologics for IBD, though more are underway. There’s currently no way to predict with certainty how your body might respond to a particular biologic.

There are several factors your doctor can consider when determining the right treatment option for you. Such considerations include:

• active disease or disease remission
• disease severity
• previous treatments and the response
• age and other health conditions
• quality of life
• potential treatment risks or side effects
• personal preferences, such as the route of providing a drug or out-of-pocket costs

It can take some trial and error to find the right IBD treatment. A different biologic type may yield better results if one biologic doesn’t provide relief. Sometimes, you may develop resistance to a biologic over time. Let your doctor know if a treatment doesn’t improve your symptoms.

Researchers are currently exploring the effectiveness of combining biologic treatments for IBD and giving medications in different sequences to help people enter long-term remission. These new strategies and therapy developments may change how doctors treat IBD in the future.

In the meantime, it may be a good idea to take an active role in your care, working with your doctor to assess your treatment along the way.