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Side Effects Of Biologics For Ulcerative Colitis

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If Your Doctor Has Recommended Infusion Therapy Let Infusion Associates Help You

Other major side effects due to immunomodulators and/or biologics in our IBD patients

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Why Have I Been Prescribed Biologics For Inflammatory Bowel Disease

Biologic medicines are relatively new, but have been shown to be effective in treating and maintaining remission in people with moderate to severe Crohns disease and ulcerative colitis. They may be an option when other medicines, such as immunosuppressants and steroids havent been effective.

However, biologics dont work for everyone and can also stop working after youve been taking them for a while.

Which Biologics Treat Ulcerative Colitis

Biologics are drugs that change how your immune system works. Theyâre made from living cells. They can ease inflammation by blocking proteins that play a role in UC.

Your doctor might suggest a biologic when standard treatments fail. That means you take medication but UC symptoms still cause a lot of problems, including:

  • More than five bowel movements a day
  • Blood in your poop or on the toilet paper
  • Interfering with work or school
  • Trouble doing everyday things

There are five biologics approved to treat moderate to severe UC. They fall into different groups based on which protein they target. They include:

Anti-tumor necrosis factor inhibitors: Your doctor will likely start you off on an anti-TNF biologic. Scientists know a lot about these drugs. Thereâs also some evidence they may work better than other types of biologics in people whoâve never tried a biologic before.

Examples include:

Integrin receptor antagonists. This type of biologic only targets cells in the lining of your gut. Thereâs evidence they may be safer than other biologics. Keep in mind all biologics are considered safe. But integrin receptor antagonists seem to be less likely to raise your odds of infections. We need more research to know for sure. Vedolizumab is approved for UC.

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Body Systems Harmed By Ulcerative Colitis

According to research, an individual with ulcerative colitis may also develop arthritis, eye inflammation, liver diseases, and osteoporosis. Researchers have yet to determine how the disease affects these other health problems, but they believe that inflammation caused by the immune system may be connected. In some patients, a condition that involves areas outside of the large intestine may resolve itself when ulcerative colitis is treated.

At least five percent of people with ulcerative colitis develop colon cancer, a higher rate than for individuals without the disease. The risk of colon cancer increases in each decade following the diagnosis of ulcerative colitis. Healthcare professionals may use colonoscopy to screen individuals with the disease for colon cancer.

The following herbal remedies can help manage the symptoms of ulcerative colitis:

An increased vitamin C intake can have a protective effect, and vitamin C-rich foods are linked with a longer remission phase among patients with ulcerative colitis. Some of these foods include:

These remedies can help send ulcerative colitis into remission:

Interleukin Inhibitors For Ulcerative Colitis:

Figure 1 from Cytokines in inflammatory bowel disease

Interleukin inhibitors are the biologics used to suppress the immune system. Interleukins of different types are responsible for the proper functioning of the immune system as well as the movement of immune cells. In the case of UC, they target the proteins that direct inflammation.

It is considered one of the most effective treatments with the infusion of a single dose which is followed by another dose after 8 weeks.

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Side Effects Of Biologic Medication For Ulcerative Colitis

Among the biologics, are the anti-TNF agents, including Infliximab , adalimumab , and golimumab . These are all associated with an increased risk of infections as well as a slight excess risk for melanoma skin cancer. These agents should be avoided in patients with severe heart failure, as they may worsen the condition.

Other biologic drugs such as Vedolizumab and ustekinumab seem to have better safety profiles and are not linked to increased infection rates to date.

How Do You Take Biologics

Biologics are administered as either a self-injection you can do at home or as an infusion at an infusion center. Dr. Nandi says it’s all about which mode you’re more comfortable with: “Ultimately, with giving yourself a shot, there’s more pressure. Typically, we give patients a sample pen, without the drug in it, so that they go through the process of getting mentally prepared .” Depending on the medication, you’d need to self-inject every two to eight weeks.

If the idea of sticking yourself with a needle makes you cringe, consider the infusion route: At the infusion unit, the nurse does the work, which can relieve the anxiety associated with administering your own medicine, explains Dr. Nandi. Infusions can take 30 minutes, one hour, or two hours, and they are given usually every four or eight weeks.

Gaby DuFour, a UC patient who lives in Chicago, receives Remicade infusions to manage her UC symptoms. “I get my dose more frequently when they were too spread out, I still experienced symptoms,” she says.

She equates her infusions to a phone battery: “Your power level gets low, but you can still text, Instagram, and call until it gets to 0%. Maybe it slows down a bit when it gets under 10%, but nothing too noticeable.” Then the infusion charges you back up to 100%.

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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.

The Side Effects Of Medication For Ulcerative Colitis

Bad Experience with Remicade (Infliximab) Infusion | My IBD Journey with Ulcerative Colitis

In the 1950s, British doctors Truelove and Witts introduced corticosteroids for the treatment of ulcerative colitis, turning a disease occasionally associated with death into a chronic condition.

However, corticosteroids are associated with many side effects, including increased risk of infections, osteoporosis, increased risk of diabetes and hypertension, cataracts, mood changes, and difficulty sleeping , to name a few. Therefore, steroids are not advised to be used except for short-term treatment of flares.

The past decades, however, have seen a significant advance in the treatment of ulcerative colitis with more drugs available to patients. Unfortunately, none of them are entirely free of risks and side effects.

Read Also: Living With Ulcerative Colitis Stories

Side Effects Of Biologic Treatment In Ulcerative Colitis

Usually, the side effects of biologic drugs are mild. It is common for the patients to feel tired, to experience some skin reactions, nausea, vomiting, joint or muscle pain, and fever3.

When the biologic treatment is performed by intravenous administration with infliximab, adalimumab or golimumab, the patient may report some reaction. For example, shortness of breath, hives, redness, itching and swelling of the lips and throat, or headache. If this were to happen, the infusion would be stopped in order to resume it at a slower rate. In the following administrations, the patient would be premedicated with corticosteroids.

For their part, patients treated with adalimumab or golimumab may have a skin reaction at the subcutaneous injection site.

In general, all biologic drugs can increase the chances of infection, especially respiratory infections. Therefore, health professionals recommend keeping all vaccines up to date. And, if you have any symptoms of infection such as fever or cough, it is advisable to tell your doctor.

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 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

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What About Side Effects When I Am Taking Biologics For Crohns Disease Or Ulcerative Colitis

All biologic medicines have the potential risk of side effects. Some side effects can happen straight away, as a direct response to the medicine. This can include allergic reactions, which can be very serious and require immediate medical assistance. You will be monitored closely after your initial injections and infusions to check for this type of reaction.

Some side effects may appear gradually, or after a period of time. Some can be mild and will go away on their own, and some can be serious and may require treatment. Sometimes side effects can result in you having to stop a medicine, or change to a different one.

Some people will experience no side effects at all.

Different biologic medicines have the potential for different side effects. Your IBD team will give you detailed information about the particular medicine you are taking, and you can also read the patient information leaflet included in every medicine packet. More details about the specific side effects for each medication are available in the following articles

Fda Black Box Warning

Understanding IBD Medications and Side Effects by Crohn

Remicade does have what the FDA calls a Black Box Warning. This means that at the top of the patient information packet, theres some special wording in bold thats surrounded by a black box. The reason why Remicade has this special designation is because everyone who takes this drug should be tested for tuberculosis before receiving it. Another section states that anyone who has a severe infection shouldnt take the drug, or should stop taking it if an infection develops. The last part discusses the potential risks of certain types of cancers, such as skin cancers and lymphoma. This all sounds scary, but the actual risk of cancer is thought to be very low.

What follows are some of the potential side effects of Remicade. Not all adverse effects occur in all people, and some of them are very rare. Concerns about the potential for side effects should be discussed with a gastroenterologist.

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Read Also: Causes Of Ulcer And Treatment

Box 1 Problems In Toxicity Assessment Of Biologics Used In Inflammatory Bowel Disease

  • Many patients receive multidrug treatment it is not always clear to which agent toxicity can be attributed.
  • The underlying condition can also be the cause of extraintestinal problems.
  • Rare adverse events are often not recognised during controlled trials and become apparent only after a period of widespread use.

The incidence of opportunistic infections in different groups of patients treated with infliximab was reported to vary between 0.3% and 0.9%.7 Serious infections were observed in 34% of patients treated with infliximab in clinical trials.8,9 In the trials, most patients having these serious infections received multiple concomitant therapies including immunosuppressives and corticosteroids. The TREAT registry for patients with Crohn’s disease treated with infliximab revealed an increased risk of infections which was associated with the use of corticosteroids, and not with infliximab.5

The most common infections occurring in patients with IBD treated with antiTNF therapies are upper respiratory tract and urinary tract infections. It is now generally accepted that if a patient is having moderatetosevere infection, it is advisable to postpone antiTNF therapy and to treat the infection properly first.

Biologic Treatment For Ulcerative Colitis: A Therapeutic Revolution


The last 30 years have been a revolution in the treatment of Inflammatory Bowel Disease . Healthcare professionals have incorporated into their therapeutic arsenal new molecules that have been shown to be highly effective in Crohns Diseaseand Ulcerative Colitis. In addition, these molecules have made it possible to expand the therapeutic options available to the patient and to move towards Personalized Medicine. We are talking about monoclonal antibodies.

These new drugs are based on different mechanisms of action to which we are accustomed. This is why they will allow, in the very near future, to manage the disease in a much more varied way. Experts predict that the greatest revolution in this field is yet to come. For the time being, they are getting an effective treatment forpatientssuffering from a moderate to severe outbreak and who have an unfavorable response to conventional treatments or are intolerant and/or have contraindications to such treatments.

Read Also: What Helps Get Rid Of Ulcers

Biologics May Be Used Along With Other Uc Medication

A biologic medication combined with a traditional ulcerative colitis drug may work better than either drug alone, Dr. Ullman says, but two biologics shouldnt be taken together because of an increased risk of complications.

Current guidelines also state that if you previously took a 5-ASA that wasnt successful, you shouldnt keep taking it if you move on to an anti-TNF drug, such as adalimumab or infliximab.

Do Biologics Come With Side Effects And Risks

Using Biologics to Treat Ulcerative Colitis and Crohn’s Disease – Nemours Children’s Health

Itâs safe to take these drugs on a long-term basis. And you may not have any issues with your treatment. But here are some things to consider:

Higher odds of infection. Biologics donât make you sick. But these drugs can make it harder for your immune system to fight off germs. Thereâs a chance they might reactivate viruses that are already in your blood.

Before you start biologic treatment, your doctor will check your blood for infections like:

After you start a biologic, tell your doctor anytime you have signs of an infection. Watch for symptoms such as:

  • Diarrhea or bloody poop

You can take steps to stay healthy. Wash your hands, wear a mask, and avoid close contact with sick people. And stay up to date on your vaccines. Your doctor will let you know which ones are right for you.

Side effects and other reactions. Biologics go into your body one of two ways: a shot or through a vein in your arm. You may get pain, redness, swelling, or bruising where the medicine goes into your skin.

Itâs possible to have an allergic reaction to a biologic. After a shot or infusion, get medical help right away if you notice:

  • Shortness of breath
  • Itchy skin, eyes, or lips

Tell your doctor about any new symptoms that show up when you start your biologic.

Itâs less common, but some biologics might affect your nervous system or cause a lupus-like reaction. That could trigger symptoms such as:

  • Numbness or tingling
  • Sudden swelling in your ankles or hands

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The Future Of Biosimilars

As of December 2019, a total of 26 biosimilars have been approved in the United States. But that number could grow quickly, according to Anita Afzali, MD, a gastroenterologist and the medical director of The Ohio State University Inflammatory Bowel Disease Center in Columbus.

There are more than 650 biosimilars under development, Dr. Afzali notes, adding that most are in the early stages of development. Whats to come in the United States will certainly be a hot topic of discussion.

So far in the United States, biosimilars for IBD have been approved for all the same uses as their originator drugs but have not been ruled interchangeable with those drugs. In practice, this means that pharmacists cant substitute a biosimilar for a biologic, as they could with a generic for a brand-name drug.

Afzali worries that this may become a distinction without a difference. Its easy to imagine, she says, that an insurance company or hospital system could simply cover only the biosimilar equivalent of an original biologic. In this imagined scenario, she says, the state or the insurance or the pharmacist is saying, You have to try the biosimilar, even when a person has already experienced side effects from the biologic that might become worse with the biosimilar.

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