What Is The Safest Biologic For Ulcerative Colitis
The benefits of biologics may outweigh the potential risks in people with moderate-to-severe IBD.
However, biologics can affect how the immune system works. Specifically, they may impact the immune systemâs ability to ward off certain infections.
The risk of infection tends to be higher with anti-TNF agents than with other types of biologics.
The 2020 review of research found that the overall rate of serious infections in people using biologics was low. Entyvio was the safest biologic for treating ulcerative colitis. It was linked to the lowest number of infections.
The authors ranked Stelara as the next safest biologic for treating ulcerative colitis.
Biologics may carry other risks of side effects. A person should speak with a doctor about the potential risks of biologics before they use them.
However, biologics are relatively new medications. For this reason, long-term safety data are limited.
Scientists have completed fewer long-term studies on Entyvio or Stelara. The available data suggest that these biologics are safer than anti-TNF agents.
People with moderate-to-severe ulcerative colitis may need to use biologics on an ongoing basis to keep the condition in remission. Stopping treatment with biologics may cause a relapse, during which symptoms return.
More research is necessary to confirm if and when people can stop using biologics without experiencing a relapse.
Some research has linked biologics to modest weight gain in people with ulcerative colitis.
Talk To Your Doctor About Biologics For Crohns And Ulcerative Colitis
It is important to have open communication with your doctor about your concerns related to biologic drugs. Discuss your current condition, medical history, and any other drugs you are taking with your doctor. Ask questions about dosage, administration, and side effects of the biologic they recommend for you. Talk to your care team about all your options, and request training for self-injection if the biologic you are prescribed can be self-administered.
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Mesalazine For Ulcerative Colitis
5ASA are anti-inflammatory medications widely used for mild conditions. Since they are not immune-suppressing drugs, their safety profile is overall very good, and there is no increased risk of infections with these medications.
However, in 1% of patients, they may cause diarrhea, sometimes accompanied by fever, which can be difficult to distinguish from an exacerbation of the underlying colitis for which they were prescribed.
Other more rare side effects include pancreatitis, hypersensitivity allergic reactions, and a specific type of kidney immune inflammation , requiring follow-up urine and kidney function tests every 6-12 months in patients on regular treatment.
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Personality Functioning Mentalization And Attachment
We found only little differences between CD/UC and HC regarding mentalization and attachment.
Since the ability to mentalize has been suggested as a resilience factor for numerous psychological disorders and since various therapeutic approaches to improve the mentalization characteristics exist, the indication of mentalization deficits would have been of direct clinical relevance. Even though our data do not allow final conclusions due to the small sample size and the exploratory character, our results indicate that there are no or only a little mentalization deficits in IBD, when compared to individually matched HCs. At first glance, this seems contradictory to our previous study that reported IBD patients with active symptoms to have higher mentalizing deficits than HC . Due to the small sample in this study, it would not have been possible to detect small differences. It is noteworthy that in this study, the effect size of patients with UC compared to HC regarding mentalizing deficits was d = 0.39 and therefore comparable to the previous study. Thus, it is possible that there are small differences regarding mentalizing in patients with active IBD compared to HC at least in the subgroup of UC patients.
Anthropometric And Laboratory Findings
As shown in Table , there was a statistically significant mean difference in thrombocytes . According to Mann-Whitney-U Post-hoc test, differences between IBD-AD and HC were significant . Further, there were no statistically significant mean differences between the three groups in the following dimensions: waist circumference, waist circumference difference from norm, height, weight to height percentage, weight, BMI, BMI z-score, percentile BMI vs age, z-score height vs age, percentile height vs age and the blood values albumin , CRP , hemoglobin , ESR and leukocytes . Investigating effect sizes, the IBD-AD group scored moderately lower on BMI z-score, percentile BMI vs age, z-score height vs age and percentile height vs age.
Table 2 Anthropometrics and Blood values
Mean grip strength did not differ statistically significantly between the three groups IBD-AD, IBD-RE and HC.
Even though statistically non-significant, the mean 6MWT results indicated descriptive differences, with IBD-AD patients achieving the shortest distance compared to IBD-RE and HC . The IBD-AD also had less increase in heart rate , but still rated the intensity of the test as high as the other two groups .
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Where Can I Find Further Support
There are a number of places you can visit for support, advice or just a friendly ear.
For 24/7 counselling or crisis support, please contact Lifeline on 13 11 14 or the Beyond Blue Support Service on 1300 22 46 36.
You can maintain a healthy mind and a healthy body by working with your healthcare professional hand in hand.
So start a conversation today.
This information has been developed in partnership with Janssen Australia and New Zealand. It is provided for education and information purposes only and is not intended to replace advice from your doctor or other registered health professional.
References
- Mikocka-Walus, A. et al. Clinical Gastroenterology and Heptaology, Volume 14, Issue 6, 829-835.e1** Crohnâs and Colitis Australia. My IBD Experience â Research Report 2018
Acknowledgements:
Sections on this page were developed in 2021 by the GESA IBD Patient Information Materials Working Group
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Investigators In The Uk Examined The Records Of More Than 19000 Patients With Inflammatory Bowel Disease Including Crohns Disease And Ulcerative Colitis And Compared The Prevalence Of Psychiatric Comorbidities To Those Among Controls
The psychological well-being of patients with inflammatory bowel disease , which includes Crohns disease and ulcerative colitis, is of increasing concern, with studies pointing both to high rates of psychiatric comorbidities and the negative effects of depression and anxiety on disease outcomes.1
Take Note
- Patients with IBD often have comorbid psychiatric conditions, which can increase both their risk of poor outcomes and healthcare utilization costs.
- A new study assessed rates of anxiety episodes, depressive episodes, and depressive disorder in patients with Crohns disease and ulcerative colitis.
- All 3 measures of mental health were more common in patients with Crohns disease than in those with ulcerative colitis.
But its not just disease outcomes, say the authors of a recent study. Their data shows that mental health comorbidities in patients with IBD can have a large impact on healthcare utilizationwhich is particularly concerning in a population that doesnt take advantage of, or may not have access to, adequate mental healthcare.2
Tapping a large U.K. database
Anxiety, depressive episodes, and depressive disorder were all more common in patients with Crohns disease than in those with ulcerative colitis. Higher rates of depression and anxiety have been reported in U.S. studies of patients with IBD.3
IBD patients use more resources
Healthcare utilization rates were greater in patients with IBD than in controls:
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Psychological Burden And Personality Functioning
Group comparisons revealed differences in psychological burden and psychodynamic structural characteristics .
Figure 1. Alterations in psychodynamic structural characteristics in Crohns disease and ulcerative colitis compared to standardized healthy controls . The mean values of CD and UC were standardized according to the mean values of HC.
Psychological Burden
Depressive and anxiety-related complaints were higher in CD/UC-patients than in HC. Patients with CD/UC reported higher levels of depressive complaints than HC , and patients with UC reported higher levels of anxiety-related complaints than HC . Small to medium effect sizes were found between CD and HC in anxiety scores and in group comparison CD/UC .
Based on the established cutoffs, two patients with CD and one patient with UC fulfilled the criteria for a major depressive syndrome. Two patients with CD and three patients with UC fulfilled the criteria for generalized anxiety disorder.
Personality Functioning
Patients with CD/UC reported more deficits/alternations in psychodynamic structural characteristics than HC in the total OPD-SQ-score and several primary dimensions of psychodynamic structural characteristics . Differences in the overall sum scores were of small to medium effect sizes .
Exploratory analyses of the different psychodynamic structural characteristics revealed different patterns in CD and UC compared to HC.
Chronic Psychological Stress And Adverse Life Events In Ibd
In the 1950s, IBD was classified as a psychosomatic disorder with many early studies finding an association between IBD and psychiatric diagnoses. However, a review in 1990 of 138 such studies found most to have serious flaws, while in the seven which did not, there was no association between psychiatric disease and UC. In contrast, in a study published in 2004, Mittermaier et al reported that patients with inactive IBD had a significantly increased chance of relapse over the next 18 months if their baseline score on the Becks depression inventory was raised.
Placebo response rates in many therapeutic trials of IBD remain as high as 3040%. This response rate relates not only to subjective measures such as patients feelings of well being, but also to objective measures such as the degree of mucosal inflammation seen at endoscopy, and provides further evidence to suggest that changes in psychological state can affect disease activity.
Table 2
Summary of studies assessing association between stress and disease exacerbations in inflammatory bowel disease
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What Should I Do If I Need Help With My Mental Health
If living with IBD is impacting your mental health and wellbeing, it is important to speak up and talk to your treating team. Doctors and other clinicians are increasingly recognising that managing IBD should not solely be a medical approach. It also needs to address psychological and social health.
You may benefit from participating in psychological therapy if you are experiencing poor mental health. This might be provided by a psychologist, psychiatrist, counsellor, or other mental health trained clinician. Ideally, the practitioner that you work with should be familiar with IBD and the common links with mental health.
Psychological therapy can also aim to improve adjustment to a new diagnosis or progression of disease, increase medication adherence and self-management, facilitate health behaviour change and calm brain-gut communication.
Some of the types of psychological intervention available, amongst others, include:
How To Take Tablets And Granules
You will either take the tablets or granules once a day, or as 2 or 3 smaller doses throughout the day.
Swallow the tablets whole with a drink of water or juice. Do not break, chew or crush them. This is because some tablets have a special coating to delay when they start to work, or to protect the medicine from the acids in your stomach.
For granules, open the sachet and tip the granules onto your tongue. Swallow them whole with a drink of water or juice. Do not chew them, as some granules have a special coating.
You can take some brands with food. Check the leaflet that comes with your medicine.
If youre also taking indigestion medicines or remedies, leave a 2 hour gap before and after taking mesalazine. Indigestion treatments can affect how well the medicine works.
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Effects Of Stress On The Systemic Immune System In Humans
The effects of psychological stress on the systemic immune and inflammatory system are complex, and depend on both the duration and intensity of the stressor. Both chronic stress and acute stress are associated with alterations in systemic immune and inflammatory function which may have relevance to the pathogenesis of IBD.
How Do I Start A Conversation
It can be overwhelming and a bit stressful to start a conversation with your doctor about how youâre feeling â but it is important to know you are not a burden when you want to talk about how you are feeling.
For Daniel, knowing he can talk about whatâs on his mind with his doctor helps
It is normal to feel a bit down or anxious about your IBD and your healthcare professional can provide a safe space for you to share how you are feeling and provide support when you need it.
Simply filling out this wellbeing checklist can be a good starting point. Taking it along to your next appointment can help start a conversation.
For Catherine, being kind to herself and being open with her doctor is key to helping her feel in control of her IBD
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Personality Functioning Psychodynamic Structural Characteristics
In our study, patients with CD/UC were characterized by a higher alternation in psychodynamic structural characteristics than the matched HC sample. Since psychodynamic structural characteristics are important for adapting appropriate-to-difficult challenges in life, it is understandable that a deficit in psychodynamic structural characteristics results in a higher psychological burden when experiencing stressful life events . A higher burden and therefore a higher perceived psychosocial stress can result in an activation of the enteric nervous system, which may lead to a subsequent inflammatory relapse and symptom exacerbation in IBD . One might speculate that this biopsychosocial link is more relevant for patients with UC than for those with CD, as UC patients are characterized by more structural alternations than CD patients compared to HC. Further research should be undertaken to investigate the influence of psychodynamic structural characteristics on the psychological burden in UC in more detail.
Where To Get Help
Speaking with your doctor is the first step you should take to get help for anxiety or depression associated with UC.
Treatment may include adjusting your medication to better control inflammation. Your doctor may also prescribe an antidepressant or anti-anxiety medication to improve your mood.
They may also recommend therapy with a mental health professional. These sessions can supply you with coping methods and stress management skills. Youll also learn how to change your thinking patterns and dispel negative thoughts that worsen depression.
In addition to conventional therapy, home remedies and lifestyle changes may help improve your mental health.
Examples of healthy lifestyle changes include:
- avoiding alcohol or drugs
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Acute Psychological Stress Experimental Stress And Systemic Immune And Inflammatory Function
Examining the in vivo effects of psychological stress is difficult as stress is a subjective experience which is hard to define objectively and to simulate in a controlled experimental environment. Placing patients under sustained psychological stress would also be unethical. Despite these limitations, various experimental models have been designed which are capable of inducing mild acute psychological stress, as assessed by the ANS and HPA response.
The dichotomous listening test, where different auditory inputs are played into the subjects ears, has been one of the commonest techniques used to assess the effects of psychological stress on human gastrointestinal physiology. Difficult mental arithmetic tests , which include negative feedback and varying degrees of auditory distraction, are also used and are easily reproducible. The Trier social stress test involves an oral presentation in front of a critical audience while the Stroop word-colour interference test involves identifying the colour of ink used to write a word which is different to the meaning of the word itself for example the word blue written in red ink.
Acute stress has also been shown to cause a leucocytosis in both healthy subjects and patients with quiescent UC, with a rapid redistribution of the lymphocyte population. There is a rise in the percentages of CD8+ cytotoxic T cells and NK cells, and a corresponding increase in their cytolytic activity, as assessed by chromium release assays.
How Mental Health And Ulcerative Colitis Interact
The links between ulcerative colitis and mental health disorders are complex, with each potentially having an impact on the other in several different ways.
A study published in May 2019 in the Journal of Clinical Medicine found that the risk of depression and anxiety increases after a diagnosis of IBD.
Living with a chronic disease comes with many challenges, and in some people with ulcerative colitis, being diagnosed can bring about feelings of frustration or sadness, and cause them to become withdrawn.
Other people may be worried about specific aspects of the condition, such as having bouts of gas, diarrhea, or pain in a social situation or public place. This can directly bring about anxiety or lead them to become isolated, which may in turn cause feelings of loneliness and despair and contribute to depression.
But as noted in a review paper published in the journal Gastroenterology Research and Practice, theres evidence that both depression and anxiety are more common in people who later develop ulcerative colitis than in the general population. This link seems to be strongest when the mental health conditions are diagnosed only a short time before ulcerative colitis.
These findings suggest that both mental health disorders and ulcerative colitis may have common risk factors, and that depression and anxiety may even contribute to ulcerative colitis.
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Recognizing And Treating Mental Health Issues
The following symptoms can indicate anxiety and depression in people with ulcerative colitis:
- A spell of sudden fear or panic
- Frequent nerves or anxious feelings for six months
- Feeling anxious or uncomfortable around other people
- Recurring dreams or nightmares about traumatic events
- Avoiding reminders of traumatic events
- Feeling down, hopeless, or uninterested in doing things for two weeks
If you experience any of these symptoms, its important to discuss them with your primary care doctor or gastroenterologist.
According to the Crohns and Colitis Foundation, not everyone with a negative emotional response to ulcerative colitis will require a psychiatric consultation. Healthcare professionals that you already see may be able to provide the emotional support you need.
But if youre experiencing severe emotional difficulties or feel like you need to try new ways to cope with the disease, you may benefit from seeing a psychologist or psychiatrist.
Its important to find a therapist who is familiar with ulcerative colitis, since its helpful to know about the diseases symptoms, complications, and drug treatments when deciding how to address mental health issues.
Your gastroenterologist or primary care doctor can help you find the right therapist based on your symptoms and the type of treatment youre looking for.
Treatments that you may decide to try with your therapist include: