If a person has Crohn’s disease, a doctor may recommend taking medication as an infusion to bring about and maintain remission. These infusions will usually be with a biologic drug.
People can receive biologics intravenously. These drugs can help reduce the risk of flares and severe symptoms, but they can also cause side effects.
In this article, learn more about types of Crohn’s infusions and what to expect from this type of treatment.
These medications can help treat Crohn’s disease because they target specific parts of the body. Other common medications for Crohn’s disease, such as corticosteroids, affect the whole body.
Doctors categorize these medications based on the specific proteins they target. Not all biologics are available by infusion.
Below are some examples of these medication types.
Anti-tumor necrosis factor agents
Anti-tumor necrosis factor (anti-TNF) agents block a protein called TNF-alpha. They can help reduce Crohn’s disease symptoms and heal intestinal inflammation.
Examples of these medications include:
- adalimumab (Humira)
- adalimumab-atto (Amjevita)
- adalimumab-adbm (Cyltezo)
- certolizumab pegol (Cimzia)
- golimumab (Simponi)
- infliximab (Remicade)
- infliximab-abda (Renflexis)
- infliximab-dyyb (Inflectra)
- infliximab-qbtx (IXFI)
A doctor will choose an appropriate medication to suit an individual’s needs. For example, if a person has a fistula, the doctor may recommend infliximab.
Integrin receptor antagonists
These drug types reduce the inflammatory compounds coming into the tissues from blood vessels.
Anti-interleukin-12 and interleukin-23 therapy
A doctor may prescribe the medication ustekinumab (Stelara), which is a one-time infusion. The person can then give themselves injections every 8 weeks after the first infusion.
The drug works by blocking proteins that contribute to inflammation.
A doctor will instruct a person on how to prepare for a Crohn’s infusion.
Infusions usually take place in an outpatient treatment center or hospital, but some people may receive them at home. A doctor may visit to give the infusion.
As there may be a risk of an allergic reaction, it may be best to have the first few infusions at a hospital or outpatient center.
A doctor will send a prescription to the infusion center with details about the type, dose, and length of the infusion.
Here are some tips to help a person prepare for treatment:
- Ensure that the doctor knows which other medications are in use, including any over-the-counter (OTC) treatments and supplements.
- Find out if any dietary precautions are necessary before the treatment.
- List any concerns and talk with the doctor about them in advance.
- Wear comfortable clothes.
- Allow time to rest at home after the infusion, just in case it is necessary.
- Take a book or magazine to pass the time during the treatment.
Infusions during COVID-19
During the COVID-19 pandemic, a person may also wish to ask a doctor the following:
- Can someone come with me to the appointment?
- What is the checking in procedure?
- What type of protection are doctors using to prevent the spread of the virus?
- What should I do if I have symptoms that may be due to COVID-19?
- If I am isolating at home, how can I arrange my appointments?
- Can I attend if I have been near someone with the virus but do not have any symptoms myself?
- Do I need to take a test before attending the hospital?
Before starting treatment, a person should talk with their doctor about what to expect.
For the treatment to be effective, the person will likely need regular treatment with the drug. They will need to follow the schedule their doctor outlines.
If the person misses an appointment for any reason, they should contact their doctor to discuss options with them.
During the treatment
Although the procedure may vary slightly, people can usually expect the following when they have a Crohn’s infusion:
- First, a nurse will start an intravenous (IV) line. This involves inserting a small, thin catheter into a vein, usually in the arm.
- Next, the nurse will connect the medication to the IV. The medication is usually in an IV bag or bottle with a tube to connect to the IV in the person’s arm.
- When this is ready, the infusion will begin. Because there is a risk of an allergic reaction, the nurse may start the infusion at a slightly lower concentration and increase it over time. A person should alert the nurse about any potential symptoms of an allergic reaction, such as difficulty breathing, a rash, nausea, or a headache.
- When the infusion is complete, a doctor may recommend that the person has someone else drive them home and monitor them in case an allergic reaction or any side effects occur.
After the infusion
A person will not usually experience immediate positive effects after having a Crohn’s infusion. In fact, it may take several weeks to notice the symptoms improving.
The length of time an infusion takes, and how often a person must receive them, varies among different medications.
For example, an infusion of vedolizumab will take around 30 minutes to deliver. After the first dose, the person will need to receive another one after 2 weeks, then 6 weeks later, then every 8 weeks after that.
With ustekinumab, however, a person will receive a one-time infusion at a hospital or infusion center, followed by injections at home every 8 weeks.
The cost of treatment with biologics can be high.
The authors of one 2017 report put the total cost of treatment with vedolizumab in the first year at $41,320, with subsequent years costing $36,197.
For infliximab, the cost of the first year was $38,782, and it was $49,897 for subsequent years. These costs were for treatment in a hospital setting.
Insurance companies and Medicare may cover the cost of Remicade and other biologics for Crohn’s disease. A person should check their insurance plan before deciding on treatment.
Crohn’s infusions can cause a range of side effects. Many of these are specific to the particular medication the person receives.
When receiving any medication intravenously, it is possible to have an allergic reaction or local reaction at the IV site.
For this reason, people should always ensure that they are up to date with their immunizations before receiving infusions.
Some other risks associated with Crohn’s infusions and biologics include:
- changes to liver function
- arthritis or joint pain
- a slightly higher risk of cancer, including lymphoma, solid malignancy, and skin cancers
- a lupus-like reaction, which includes muscle aches, joint pain, a rash, and a fever
People should always discuss the risks of certain medication types with a doctor. For example, receiving the Tysabri infusion increases the risk of a condition called progressive multifocal leukoencephalopathy.
This condition occurs in people who have the John Cunningham virus, which does not usually cause any symptoms. As a result, doctors will test people for this virus before beginning Tysabri infusions.
There may also be interactions with other drugs. People should make sure that their doctor knows about all the drugs, supplements, and OTC medications they are taking before starting a new treatment.
A doctor may recommend Crohn’s infusions alongside other therapies to increase the treatment’s effectiveness.
For example, a person may take an immunomodulator, which changes the body’s immune system, as well as biologic infusions. This is known as combination therapy.
However, there are also greater risks of side effects when using both medications. Some of these risks can be serious. For example, if a person uses anti-TNF medications and immunosuppressants, such as azathioprine (Imuran), they are at greater risk of developing lymphoma.
Some other options a doctor may recommend or prescribe include:
- aminosalicylates, such as balsalazide (Giazo, Colazal), to manage inflammation
- corticosteroids, to reduce inflammation
- a liquid diet, if a doctor recommends bowel rest
- surgery, in some cases
- adjusting the diet
Crohn’s infusions are targeted treatments that can help Crohn’s disease go into remission permanently.
People should consider the potential benefits and risks when using this medication.
A doctor can speak with a person who is considering infusions about the possible effects based on their individual medical history. This can help them make the most informed decision when managing their Crohn’s disease.