Because biologic therapy is a newer form of Crohn’s disease treatment, you may not know that much about it yet. From how it's administered to how well it works, here are the answers to frequently asked questions about biologic drugs for Crohn’s disease.
Why is my doctor recommending biologic therapy to treat my Crohn’s disease?
Biologics are usually recommended for people with more aggressive disease that’s harder to control, says Andelka LoSavio, MD, an assistant professor of gastroenterology with Loyola University Health System in Chicago. You may have already taken other medications that didn't work well or have stopped working, or you may have developed Crohn’s disease at a very young age. These circumstances prompt doctors to consider stepping up to biologic therapy for Crohn’s disease treatment.
How are biologics given?
Biologic therapy is more complex than taking pills. Some biologic drugs are given through what’s called infusion therapy, usually an outpatient procedure during which you'll be given the medication intravenously for about two hours. How often you'll need an infusion depends on the specific medication, but it’s typically about every two months.
Other biologics are taken as an injection that you give yourself at home on a regular schedule, such as every two to four weeks.
Work with your doctor to find the right biologic treatment for you.
What are the side effects of biologics?
Side effects of biologics can vary from minor to serious. Minor side effects include a rash or skin redness at the site of injection, Dr. LoSavio says. For people who have a more severe reaction, the rate of infusion may be changed or you may need to take a steroid or antihistamine before treatment.
A greater concern for doctors and people with Crohn’s disease is the risk of infection. Biologics are considered immunosuppressive medications, which means they can reduce your body’s ability to fight off infection, LoSavio says.
Before starting biologic therapy, your doctor will assess your overall health to monitor other health concerns. For example, you’ll be tested for tuberculosis because taking a biologic could reactivate this lung disease. Your doctor will also ask if you have hepatitis B or heart disease. If you do, you may still be able to receive biologic therapy, but you’ll need extra monitoring and may need to work with other healthcare specialists to help manage your risk factors.
“Understanding the side effects is important, but you may be considering the use of a biologic drug because your disease is more aggressive or because other therapies have failed," says LoSavio. "You have to weigh the risks and benefits."
When you're on biologic therapy, your doctor will perform regular exams, including blood tests, to make sure your body is properly fighting infections. Women may also be reminded about getting regular Pap smears to look for any cervical abnormalities that may develop while taking a biologic drug.
Do biologics increase the risk of cancer?
“The increased risk of cancer from using biologics is small,” says Claudia Gruss, MD, a gastroenterologist in Georgetown, Conn., and a spokeswoman for the American Gastroenterological Association. There may be a small risk of developing non-Hodgkin lymphoma, but again you have to weigh the treatment benefits against this risk.
Crohn’s disease and biologics may also be linked to an increased risk of skin cancer. A study published in the journal Gastroenterology in 2012 found a greater risk for melanoma and non-melanoma skin cancer in a group of people with inflammatory bowel disease, which includes Crohn’s disease. The risk of melanoma increased further when the participants took biologics. This is another risk that your doctor can help you reduce and monitor.
Will I use biologic therapy along with other medications?
For most people, the answer is yes, Dr. Gruss says. You may also be prescribed more traditional immunomodulator and anti-inflammatory drugs. By using a combination approach, your doctor can help target different inflammatory responses in your body related to Crohn’s disease.
How effective are biologics for Crohn’s disease?
The research remains unclear, but biologics appear most effective if you haven’t used this type of medication in the past. Generally speaking, there’s about a 60 percent effectiveness rate if you’re new to biologics, Gruss says. However, that percentage can decrease with time. This is why you might need a number of medications to treat Crohn’s disease effectively.
How long will I be taking biologics?
“You may need to use it for the foreseeable future,” LoSavio says. The data still aren’t clear regarding how long you should use a biologic for Crohn’s disease treatment, but it does appear that if you go off the drug, you're more likely to have a disease flare, she says.
What if my health insurance won’t cover the costs?
Biologic therapy is expensive because it’s newer and there are no generic alternatives available, Gruss says. However, she says she's spoken with insurers who weren’t covering the medications to point out that it would cost more if a person with Crohn’s disease had to be hospitalized for a complication, and that has persuaded some insurers to include biologics in their coverage.
If you aren’t sure if you can afford the medication, talk to your doctor. Hospitals may help cover the cost through charitable programs, LoSavio says. Plus, drug manufacturers often have assistance programs to help cover costs you can’t afford. You can find out more about those programs on the drug companies’ websites.