The Potential Downsides Of Biologics
While biologics may be a promising option for treating your ulcerative colitis, not every drug is suited to every patient.
We will work with patients for a while to tailor a treatment plan that is right for them, says Dr. Raffals. That may mean trying different biologics and small-molecule drugs, and, of course, taking into account what the patients insurance will cover.
A persons lifestyle, demographic factors, and the severity of the disease are all considerations in the choice of whether or not to use biologics, and which of them is the best option.
Some potential downsides of taking biologics include:
If youre considering biologics for treatment, speak to your doctor to find out whats best for you. As Tsynman says, At the heart of the decision is the relationship between the patient and the physician and specifically exploring what works best for each individual.
Additional reporting by Jordan M. Davidson.
What To Expect During Treatment
The first time you receive Stelara, it will be given through an IV infusion at a doctors office or clinic. The amount given in your first dose will be determined by your weight.
After your first IV dose, you take Stelara as an injection at home. You can self-inject or have a friend or loved one help you.
Stelara comes in a prefilled syringe with a plunger top. No matter what your initial infusion dose was, your ongoing doses will be 90 milligrams. No measuring is necessary.
The needle cover on the syringe contains latex, so make sure to let a healthcare professional know if you have a latex allergy.
Stelara can be injected into any of these sites:
- upper front thigh
- abdomen, except for a 2-inch radius around your belly button
- outer upper arm
Before injecting, always check the expiration date on the box. You should also inspect the liquid in the syringe. It should range in color from clear to pale yellow. It may contain a few small, white particles. If the liquid is cloudy, frozen, dark yellow, or has large particles, do not use it.
Biologic Therapy Can Lead To Long Periods Of Remission
Biologics are broadly effective at reducing chronic inflammation in UC. Were seeing fewer hospital admissions, fewer surgeries, and less disability from ulcerative colitis with the use of these drugs, says Ullman.
They are also long-term maintenance drugs, so once you start on biologic therapy, youll need to keep taking it to prevent your UC from flaring. Dont stop treatment without consulting with your doctor.
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Biologics Are Given By Injection
Some biologic medications are available as a shot thats given once or more every month, with more frequent starter doses in the beginning. You or a loved one can learn to administer these injections at home. Other biologics require an intravenous infusion, which typically happens every 8 weeks after several initial infusions. Depending on the drug, an infusion can last about 30 minutes or 2 to 4 hours.
Can I Switch Between Stelara And Humira
The short answer: Its possible.
Details: Stelara and Humira are both biologic disease-modifying antirheumatic drugs . Biologics are newer, targeted therapies derived from living sources. And DMARDs suppress certain parts of your immune system to help reduce inflammation . This helps prevent damage to your healthy tissues and symptoms of your condition.
In some cases, your doctor may recommend the switch. For example:
- If you have psoriatic arthritis thats not controlled with Stelara, your doctor may suggest switching to Humira. This switch is recommended by the American College of Rheumatology.
- According to American Gastroenterological Association treatment guidelines, Stelara and Humira are both first-choice treatments for moderate to severe ulcerative colitis. So if you need to switch because of side effects or costs, it may be possible.
However, choosing to switch between these drugs isnt always a simple decision. Your doctor may or may not recommend it based on many factors, such as:
- your condition and other medical treatments
- your experience with past treatments
- your risk for serious side effects
- any side effects youve had
- your other medications
- recommendations from the latest treatment guidelines
- drug costs or availability
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What Should I Tell My Doctor Before Starting Humira
Tell your doctor about all of your health conditions, including if you:
- Have an infection, are being treated for infection, or have symptoms of an infection
- Get a lot of infections or infections that keep coming back
- Have diabetes
- Have TB or have been in close contact with someone with TB, or were born in, lived in, or traveled where there is more risk for getting TB
- Live or have lived in an area where there is an increased risk for getting certain kinds of fungal infections, such as histoplasmosis, coccidioidomycosis, or blastomycosis. These infections may happen or become more severe if you use HUMIRA. Ask your doctor if you are unsure if you have lived in these areas
- Have or have had hepatitis B
- Are scheduled for major surgery
- Have or have had cancer
- Have numbness or tingling or a nervous system disease such as multiple sclerosis or Guillain-Barré syndrome
- Have or had heart failure
- Have recently received or are scheduled to receive a vaccine. HUMIRA patients may receive vaccines, except for live vaccines. Children should be brought up to date on all vaccines before starting HUMIRA
- Are allergic to rubber, latex, or any HUMIRA ingredients
- Are pregnant, planning to become pregnant, breastfeeding, or planning to breastfeed
- Have a baby and you were using HUMIRA during your pregnancy. Tell your babys doctor before your baby receives any vaccines
Things To Know About Biologics For Ulcerative Colitis
Biologics are one option in the treatment of ulcerative colitis. Heres what you should know before starting biologic therapy.
If you have moderate to severe ulcerative colitis and aren’t responding to or can’t tolerate traditional medications, such as aminosalicylates or immunomodulators, your doctor may ask you to start taking a biologic.
Biologic drugs, such as adalimumab and infliximab, can help stop inflammation and keep your disease in remission if other UC medications arent effective. But these drugs are also complex and may not work for everyone, so its important to learn more about them if youre new to biologic therapy.
Here are 10 key facts about biologic drugs for UC.
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How Long Does Stelara Take To Work
Everyone responds differently when taking a new medicine, and Stelara doesnt work for everyone. Clinical trials have shown that some patients start to see results within three weeks in Crohnâs disease and two weeks in ulcerative colitis, but most people who respond to Stelara see an improvement within six weeks. In some people it could take longer. You may be taken off Stelara if you have any serious side effects or if you have not responded within 16 weeks of starting your treatment.
- Cimzia is approved to treat Crohnâs disease.
- Cimzia is usually given at home by injection.
- Cimzia is given initially three times in a series of two injections, two weeks apart, followed by two injections every four weeks.
- Common side effects include respiratory infections, viral infections, rashes, and urinary tract infections.
- If you are pregnant or plan to become pregnant, you and your doctor should decide if you should take Cimzia.
- A low amount of Cimzia may pass into the breastmilk.
- Cimzia needs to be refrigerated.
Humira For The Treatment Of Ulcerative Colitis
Ulcerative colitis in paediatric patients
HUMIRA® is the only subcutaneous therapy approved by the US Food and Drug Administration for the treatment of ulcerative colitis in paediatric patients aged five years and older.
The drug was developed by biopharmaceutical company AbbVie, which was founded in January 2013 by US-based healthcare company Abbott Laboratories as a spin-off of its research-based pharmaceuticals business.
HUMIRA is available in a single-dose pre-filled pen as a clear and colourless solution in 80mg/0.8ml, 40mg/0.8ml and 40mg/0.4ml dosage strengths for subcutaneous administration.
It is also available as single-dose pre-filled syringe in 80mg/0.8ml, 40mg/0.8ml, 40mg/0.4ml, 20mg/0.4ml, 20mg/0.2ml, 10mg/0.2ml and 10mg/0.1ml dosage strengths.
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Whats The Dosage Of Humira For Children
The dosage of Humira for children depends on the condition the drug is used to treat. It also depends on the childs body weight in kilograms .* Below are the recommended Humira dosages for children.
* One kg is equal to about 2.2 pounds .
Dosage for juvenile idiopathic arthritis
Humira is prescribed to treat juvenile idiopathic arthritis in children ages 2 years and older.
For this purpose, the typical Humira dosages are as follows:
- In children who weigh 10 kg to 14 kg : 10 mg every other week
- In children who weigh 15 kg to 29 kg : 20 mg every other week
- In children who weigh 30 kg or more: 40 mg every other week
Childrens dosage for Crohns disease
Humira is used to treat Crohns disease in children ages 6 years and older.
The typical Humira dosages for this use are as follows:
- In children who weigh 17 kg to 39 kg :
- On day 1: 80 mg
- On day 15: 40 mg
- Starting on day 29: 20 mg every other week
- On day 15: 80 mg
- Starting on day 29: 40 mg every other week
Childrens dosage for hidradenitis suppurativa
Humira is prescribed to treat hidradenitis suppurativa in children ages 12 years and older.
For this purpose, the typical Humira dosages are as follows:
- In children who weigh 30 kg to 59 kg :
- On day 1: 80 mg
- Starting on day 8: 40 mg every other week
- On day 15: 80 mg
Childrens dosage for uveitis
- On day 8: 40 mg
General Information About The Safe And Effective Use Of Stelara
Medicines are sometimes prescribed for purposes other than those listed in a Medication Guide. Do not use Stelara for a condition for which it was not prescribed. Do not give Stelara to other people, even if they have the same symptoms that you have. It may harm them. You can ask your doctor or pharmacist for information about Stelara that was written for health professionals.
Ulcerative Colitis And Overcoming The Fear Of Using Biologics
Ulcerative colitis can have a significant impact on your life. This inflammatory bowel disease causes chronic inflammation and ulcers in your large intestines.
You may have led an active life before developing UC. Since receiving a diagnosis of UC, however, you may have limited activity outside the house because youre fearful of having a flare-up in a public place.
Although this disease is unpredictable, several treatments can help manage symptoms and may induce remission. Remission is a period marked by no symptoms or flare-ups. It occurs when therapy successfully controls inflammation.
After diagnosing UC, your doctor may prescribe an anti-inflammatory medication as the first place to start. This medication treats symptoms of UC by reducing inflammation in your intestines.
If this medication doesnt work, the next treatment is often an immunosuppressant drug. UC can develop from an abnormal immune system response to normal bacteria in your gut. These medications treat the condition by suppressing your immune system.
Your doctor may prescribe an immunosuppressant along with an anti-inflammatory medication.
Anti-inflammatory and immunosuppressant drugs dont always bring about remission or adequately relieve symptoms of UC. Some people require a different therapy called biologics.
But even if your doctor recommends biologics, you may be hesitant to begin these medications. Learning more about this treatment may ease some of your worries.
Pregnancy And Breastfeeding While Taking Stelara
It isnt known whether Stelara is safe to take while either pregnant or breastfeeding. Studies in pregnant animals didnt show harm to the fetus when Stelara was given to pregnant females. Animal studies also showed that, when Stelara was given to lactating females, the drug passed into breast milk.
However, its important to remember that animal studies dont always predict what will happen in people. There isnt enough information to know for sure how the drug may affect human pregnancy or breastfeeding.
If you have additional questions about using Stelara while pregnant or breastfeeding, talk with your doctor.
If you took Stelara during a past pregnancy or if youre currently taking it during pregnancy, youre encouraged join a pregnancy registry. The goal of this registry is to help doctors and people taking the drug learn more about the drugs safety. Consider calling the registry at 866-626-6847. Or you can visit the program website.
Stelara is approved to treat the following in certain conditions:
- moderate-to-severe plaque psoriasis in adults, as well as children ages 6 years and older
- moderate-to-severe ulcerative colitis in adults
Regardless of the condition its used to treat, side effects from Stelara arent common. Most side effects that occur are usually mild, and tend to go away on their own.
Rarely, Stelara may cause some serious side effects. Contact your doctor if you experience:
Get emergency medical help right away if you experience:
What Are The Side Effects Of Asacol And Humira
Kidney dysfunction has been associated with mesalamine. Kidney function should be evaluated prior to and periodically during mesalamine therapy.
Mesalamine may cause an acute intolerance syndrome that resembles a flare of inflammatory bowel disease with cramping, abdominal pain, and bloody diarrhea. Fever, headache, itching, and rash also may occur. Symptoms usually subside once mesalamine is discontinued.
Mesalamine enemas contain sulfites and should be avoided in persons who are sensitive to sulfites.
Since mesalamine is related to aspirin in structure, individuals who are allergic to aspirin should not take mesalamine.
The most common side effects are:
- nausea and
- stomach upset.
Adalimumab may cause swelling, redness, pain and itching at the site of injection. Adalimumab suppresses the immune system and is therefore associated with minor infections of the urinary tract, respiratory tract, and sinuses. Like other drugs that block TNF, use of adalimumab also has been associated with serious infections such as tuberculosis, and fungal infections. Individuals with active infections should not be treated with adalimumab.
Other side effects of adalimumab include:
- hypersensitivity reactions and
- reduced levels in the blood of platelets and red cells .
Adalimumab may increase the risk of reactivating hepatitis B virus in chronic carriers of the virus.
Biologics Arent Considered A First
Although many doctors believe its better to start a biologic drug sooner rather than later, its not likely to be your first ulcerative colitis treatment. The current indications for biologics in ulcerative colitis are for people who havent responded to traditional medications or are dependent on corticosteroids to relieve their symptoms, says Thomas Ullman, MD, chief of the division of gastroenterology at the Albert Einstein College of Medicine in New York City.
Its possible, though, that your doctor will recommend a biologic early in the course of your treatment if your ulcerative colitis reaches a certain threshold of severity. This decision will likely depend on your doctors personal judgment and experience.
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What Strengths Does Stelara Come In
Stelara is available in either a single-dose prefilled syringe or a single-dose vial, both of which can be given by subcutaneous injection. The prefilled syringe and the vial both come in a strength of 45 milligrams per 0.5 milliliters of solution. In addition, the prefilled syringe is available in a strength of 90 mg/mL.
When given by IV infusion, Stelara comes in a single-dose vial thats available in one strength: 130 mg/26 mL.
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What Is The Most Important Information I Should Know About Humira
You should discuss the potential benefits and risks of HUMIRA with your doctor. HUMIRA is a TNF blocker medicine that can lower the ability of your immune system to fight infections. You should not start taking HUMIRA if you have any kind of infection unless your doctor says it is okay.
- Serious infections have happened in people taking HUMIRA. These serious infections include tuberculosis and infections caused by viruses, fungi, or bacteria that have spread throughout the body. Some people have died from these infections. Your doctor should test you for TB before starting HUMIRA, and check you closely for signs and symptoms of TB during treatment with HUMIRA, even if your TB test was negative. If your doctor feels you are at risk, you may be treated with medicine for TB.
- Cancer. For children and adults taking TNF blockers, including HUMIRA, the chance of getting lymphoma or other cancers may increase. There have been cases of unusual cancers in children, teenagers, and young adults using TNF blockers. Some people have developed a rare type of cancer called hepatosplenic T-cell lymphoma. This type of cancer often results in death. If using TNF blockers including HUMIRA, your chance of getting two types of skin cancer may increase. These types are generally not life-threatening if treated tell your doctor if you have a bump or open sore that doesnt heal.
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It May Take Time For Biologic Drugs To Take Effect
When you start taking an anti-TNF drug, it may take up to 8 weeks to notice any improvement in your UC symptoms, according to the Crohns and Colitis Foundation. While some people notice an immediate improvement, the possibility of a delayed effect means youll need to continue your treatment for several weeks before concluding that it isnt effective, if that turns out to be the case.