Biologics for Ulcerative Colitis: Benefits, Brands, and Cost

Ulcerative colitis (UC) is a long-term, chronic inflammatory bowel disease. People with UC may have periods of severe symptoms followed by periods of remission. Since UC is a chronic disease, flare-ups and symptoms should return, and proper treatment can make the disease easier to live with.

One treatment option for UC is taking organic products. Biologics are different from other drugs like nonsteroidal anti-inflammatory drugs (NSAIDs) or traditional disease-modifying anti-rheumatic drugs (DMARDs). Depending on the disease, biologics may be a first-line treatment or a downstream treatment option.

Biologics are made from living organisms or from components of living organisms. Biologic drugs are sent to specific parts of the inflammatory process to target a particular process instead of affecting the whole body. The three types of biologics used to treat UC are anti-tumor necrosis factor (anti-TNF) agent, integrin receptor antagonists (ARI), and interleukin (IL) inhibitors.

Uses

Biologics have many medical uses, especially for the treatment of certain cancers and autoimmune diseases like rheumatoid arthritis (RA), Crohn’s disease, psoriasis, ulcerative colitis, etc.

There are approximately 300 biologics approved by the Food and Drug Administration (FDA). Types of biologics approved for treating UC include anti-tumor necrosis factor agents, an integrin receptor antagonist, interleukin-12, and interleukin-23.

Biologics approved by the FDA for the treatment of ulcerative colitis include:

• Anti-TNF agents: Humira (adalimumab), Simponi (golimumab) and Remicade (infliximab)
• Integrin receptor antagonist: Entyvio (vedolizumab)
• Interleukin 12 and Interleukin 23 antagonist: Stelara (ustekinumab)

Uses not indicated

Although not approved, some doctors prescribe biologics to treat other conditions. A 2020 study revealed effective off-label use in dermatology. Experts expect off-label use for inflammatory skin conditions to increase in the future.

Before taking

For people with ulcerative colitis, biologics should be used as the first-line treatment for moderate to severe symptoms. This means that instead of working on these drugs after other treatments (like NSAIDs and DMARDs) have failed, doctors can prescribe biologics first.

Working with a health care provider to assess disease activity, other medical conditions, risk factors, and other factors will determine if and when biologics are right for you.

Precautions and contraindications

Although organic products can make huge positive changes, there are some precautions you should take:

• Infection: People who start biologics should be aware of the increased risk of infection when taking biologics. Since biologics affect the immune system, they can affect its ability to identify and repel infections. In addition, biologics can reactivate previous infections, including tuberculosis and hepatitis.
• Medical background: If you have a history of cancer, diabetes, heart disease, or a nervous system disorder, your healthcare professional should be told. Current or past treatment for these conditions may put you at a greater risk of infection when you take biologics.
• Vaccination: Live vaccines are not recommended when using a biological product. It is suggested that you do these vaccinations at least one month before the biological administration. While this is true, vaccinations are essential in helping you prevent infections because the function of your immune system is suppressed by biologicals.

According to a 2020 review, the authors found the rate of severe infection in people taking biologics to be low, and they named Entyvio as the safest option for moderate to severe UC.

Be sure to track visits to your health care provider and take note of any new or worsening symptoms. Avoid drug interactions by keeping a list of medications and sharing medication changes with any doctors you see.

Special considerations should be taken for pregnant people and those planning to become pregnant. Research is still needed to see what the significant effects or long term effects of biologics are.

Dosage

Biologics are administered by injection or intravenous (IV) infusion. The dosage depends on the specific biological product:

• Entyvio (vedolizumab) is given as an infusion in a doctor’s office, hospital or infusion center. The recommended dose is 300 milligrams (mg) at zero, two, and six weeks, and then eight weeks thereafter. If no improvement is observed, it should be discontinued at week 14.
• Humira (adalimumab) is given as an independent injection (or with someone else’s help). Humira is started with four injections, followed by two injections two weeks later, then one injection every two weeks thereafter. Humira should be refrigerated before use.
• Remicade (infliximab) is given by IV starting with three doses. After the first dose, the second is given two weeks later and the third four weeks later.
• Simponi (golimumab) is given by injection at home. Dosage begins with two injections, then one injection two weeks later and one injection every four weeks thereafter. Simponi should also be refrigerated.
• Stelara (ustekinumab) is the latest commonly used biologic for UC. It is a combination of injection and infusion. The first dose is given by infusion and the next dose is given by injection at home. Stelara must be refrigerated.

Side effects

Biologics can cause side effects which can range from mild to severe. Depending on the biologic, there are different side effects to expect.

Common side effects include:

• Entyvio: Infections, joint pain, nausea, fever, fatigue, cough and itching with or without rash
• Humira: Pain or irritation at the injection site, headache, rash and nausea
• Remicade: Abdominal pain, nausea, fatigue and vomiting
• Simponi: Pain or irritation at the injection site, upper respiratory infection and viral infections
• Stelara: Injection site reactions, infection and vomiting

Warnings and interactions

Be aware of the possible side effects of biologics and talk to your health care provider about any therapies you have taken in the past or are using now. Since biologics compromise the immune system, getting vaccinated against infections and being aware of new or worsening symptoms is essential.

People taking Entyvio should not use other anti-TNF medicines, such as Humira (adalimumab), Remicade (infliximab), Simponi (golimumab), Enbrel (etanercept), Cimzia (certolizumab), Gilenya (fingolimod) and others. Combining these medicines with Entyvio may increase the risk of progressive multifocal leukoencephalopathy (PML), rare brain infection and other infections.

Simponi and Humira must also not be combined with Orencia (abatacept), Kineret (anakinra) or other TNF inhibitors.

Stelara should not be used in people with known hypersensitivity to ustekinumab or to any of the inactive ingredients of the medicine. Stelara should also be used with caution with other immunosuppressive drugs.

Other drugs that may interact with these biologics include:

A word from Verywell

Biologics may be the best treatment for your ulcerative colitis if you are living with moderate to severe symptoms. Work with your health care provider to find the best treatment for you, and weigh the pros and cons. Biologics have the potential to dramatically improve the quality of life, but research is ongoing. Working with your healthcare team to disclose all past and present treatments is critical to the success of treatment.