Biologics are a targeted treatment for moderate to severe Crohn’s disease. Doctors currently prescribe several types of biologics for Crohn’s, all of which work differently to help manage inflammation.

This treatment guide addresses how biologics for Crohn’s disease work, as well as the possible side effects.

Crohn’s disease is one type of inflammatory bowel disease (IBD) that causes inflammation in the digestive tract. Affected areas might be anywhere from the mouth to the anus. However, most people with Crohn’s experience inflammation in the area where the small intestine meets the large intestine.

Without treatment, Crohn’s can cause constant or intermittent digestive symptoms such as:

  • sudden diarrhea
  • blood in the stool
  • stomach aches or cramps
  • fatigue
  • weight loss

Some less common symptoms of Crohn’s include joint pain, mouth ulcers, and patches of swollen skin.

Doctors sometimes prescribe biologics for moderate to severe Crohn’s and are specifically targeted to treat the mechanisms of disease. Biologics for Crohn’s generally target proteins in the body that cause inflammation in the intestine.

As they specifically target certain proteins, they are less likely to cause more generalized side effects than nonbiologic medications such as corticosteroids. However, a person might have to try more than one biologic before finding the medication that works for them.

There are several biologics doctors prescribe for Crohn’s disease:

  • Anti-tumor necrosis factor (TNF) agents: These bind and block the TNF-alpha protein that causes inflammation in the intestine and other organs and tissues. Anti-TNF agents include:
    • infliximab (Remicade) — biosimilars of infliximab include Renflexis, Inflectra, and IXIFI
    • adalimumab (Humira) — biosimilars of adalimumab include Amjevita, Cyltezo, and Hymiroz
    • certolizumab pegol (Cimzia)
  • Integrin receptor agonists: These block a protein on the surface of cells that cause inflammation. By blocking this protein, the medications stop the cells from moving out of blood vessels and into tissues. Biologics in this class include:
    • natalizumab (Tysabri)
    • vedolizumab (Entyvio)
  • Interleukin 12- and 23 agonists: These target these specific proteins involved in inflammation. There are two biologics in this class:
    • ustekinumab (Stelara), which targets both interleukin 12 and 23
    • risankizumab (Skyrizi), which targets only interleukin 23

Other nonbiologic medications for moderate to severe Crohn’s include immunomodulators such as methotrexate and Janus kinase (JAK) inhibitors such as upadacitinib (Rinvoq).

A person receives biologics via injection under the skin or intravenous (IV) infusion. Common side effects include:

  • discoloration, itching, or bruising at the injection site
  • headaches or fever
  • chills
  • hives or rashes

According to one 2019 study, treatment with infliximab and other nonbiologic therapies can range from about $35,000 to $57,000 per year.

A 2020 study by the Crohn’s and Colitis Foundation found that the average healthcare cost incurred by someone with IBD was around $23,000 per year, but those taking biologic therapy incurred costs two to three times higher. The researchers also noted that those on biologics might have more severe disease and, therefore, need acute care, which may explain the higher amounts.

The Crohn’s and Colitis Foundation maintains a tool to search for Patient Financial Assistance Programs. These include co-pays from drug companies and medical scholarships, among others.