If you and your doctor aren’t satisfied with the results of your current ulcerative colitis treatment, there are many approaches to try, including a class of medications called biologics. Although biologic therapy does have some risks, these drugs have proved to be very effective for many people with ulcerative colitis.
Ulcerative colitis is characterized by inflammation in the inner lining of the large intestine, also called the colon. Although the exact cause of ulcerative colitis isn’t known yet, experts generally agree that the inflammation is caused by an overactive immune response. Part of this overreaction is excessive production of tumor necrosis factor alpha (TNF-alpha), which is a type of protein involved in the immune system’s inflammatory response.
Biologics for ulcerative colitis are designed to specifically block TNF-alpha. These drugs, such as adalimumab, certolizumab pegol, golimumab, and infliximab, are called TNF inhibitors or anti-TNF agents.
“These drugs work against TNF-alpha, which is an inflammatory substance found at higher levels in people with ulcerative colitis,” explains Alexander Ford, MD, a gastroenterologist, researcher, and associate professor at the Gastroenterology Institute at the Leeds General Infirmary in the United Kingdom. “This isn’t the actual cause of ulcerative colitis, which remains unknown, but an end product of the inappropriate inflammatory response that’s triggered for reasons we don't understand. These drugs are effective, and the likelihood of entering long-term remission is around 40 percent.”
Biologics for Ulcerative Colitis: What You Need to Know
Biologic therapy should be tailored to your needs and may be prescribed along with other drugs to be most effective. Typically, biologics are for the long term — you'll take them even when you don’t have symptoms in order to keep ulcerative colitis under control.
When taking a biologic drug, it's important that you tell all of your doctors that you're taking it. Decisions involving live vaccines, travel planning, and the treatment of some infections could be different because these biologic medications affect your immune system. You also face an increased chance of developing infections and an increased (but still low) risk for lymphoma and leukemia.
Another consideration before deciding to take a biologic medication is the cost, which can be high even if your health insurance offers some prescription drug coverage.
Once you’re taking a biologic drug, it’s important to know that your body can develop antibodies to the medication, which might make it less effective over time.
It's important to discuss these issues with your doctor when weighing the risks and benefits of taking a biologic drug for ulcerative colitis. For example, Dr. Ford and his research team reviewed studies on infection rates and found that only about 1 percent of people taking TNF inhibitors to manage ulcerative colitis or Crohn’s disease experienced an opportunistic infection. Still, that number was about three times the infection rate among people who were not taking TNF inhibitors. The risk for a tuberculosis infection was about 2.5 times greater among those taking TNF inhibitors. The findings were published in the August 2013 issue of The American Journal of Gastroenterology.
The goal for you and your doctor is to choose a treatment that will successfully put ulcerative colitis into remission, which means the symptoms would no longer be present and interfering with your daily life. At the same time, you want a treatment plan that has the least risk. Even though generalized ulcerative colitis treatment guidelines exist, the decisions you make with your doctor should be individualized to you and your body’s response to treatment strategies.