Doctors sometimes prescribe biologics to treat ulcerative colitis, depending on the severity of the condition. Biologics are medications made from living cells. They target certain cells and proteins in the immune system.

Ulcerative colitis (UC) is a condition that affects the digestive tract. A person with UC has an overactive immune system that causes inflammation in the intestines.

Biologics may help control the symptoms of UC, which can worsen sporadically, in periods known as “flare-ups” or “flares.”

In this article, we describe the types of biologics that may help treat UC. We also look into their side effects and costs.

An intravenous drip that may contain biologics for ulcerative colitis.Share on Pinterest
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In a person with UC, the immune system is overactive and mistakenly attacks cells in the body.

Biologics are medications that target cells and proteins in the immune system. They help control inflammatory diseases, including UC, and a doctor may prescribe them to treat moderate to severe UC.

Doctors also refer to biologics as targeted therapies. This is because they attack specific cells and proteins responsible for inflammatory diseases.

Corticosteroids, on the other hand, help reduce inflammation throughout the body.

Certain types of biologics may help adults who have moderate to severe UC. Finding the most effective drug that causes the fewest side effects may take some trial and error.

A biologic that treats UC may be an anti-tumor necrosis factor (TNF) agent, an integrin receptor antagonist, an interleukin inhibitor, or a Janus kinase (JAK) inhibitor. We describe each type in detail below.

Anti-TNF agents can help treat UC in adults, by reducing symptoms and helping to heal inflamed tissues.

These drugs target the protein tumor necrosis factor-alpha, which promotes inflammation and may be responsible for the development of UC.

People with UC usually see improvements in their symptoms within 8 weeks of starting treatment with an anti-TNF agent. Some people experience more immediate results.

Types of anti-TNF agents

Different types of anti-TNF agents may help treat UC:

Generic nameBrand nameDosage
AdalimumabHumiraFour injections, 160 milligrams (mg) each.
2 weeks later: Two injections, 80 mg each.
From then on: One injection, 40 mg every 2 weeks.
Adalimumab-attoAmjevitaFour injections, 160 mg each.
2 weeks later: Two injections, 80 mg each.
From then on: One injection, 40 mg every 2 weeks.
Adalimumab-adbmCyltezoFour injections, 160 mg each.
2 weeks later: Two injections, 80 mg each.
From then on: One injection, 40 mg every 2 weeks.
GolimumabSimponiTwo starter doses.
From then on: Every 4 weeks.
InfliximabRemicadeIntravenous infusion. First three doses at 0, 2, and 6 weeks.
From then on: Every 8 weeks.
Infliximab-abdaRenflexisIntravenous infusion. First three doses at 0, 2, and 6 weeks.
From then on: Every 8 weeks.
Infliximab-dyybInflectraIntravenous infusion. First three doses at 0, 2, and 6 weeks.
From then on: Every 8 weeks.
Infliximab-qbtxIXIFIIntravenous infusion. First three doses at 0, 2, and 6 weeks.
From then on: Every 8 weeks.

Adalimumab

A doctor may prescribe adalimumab if a person did not respond well to other immune suppressors, such as corticosteroids, azathioprine (Imuran), or 6-mercaptopurine (Purinethol).

In a clinical study, more than 17.3% of participants with UC who received adalimumab experienced remission after 52 weeks of the treatment.

A person can self-administer the injections at home after receiving instructions from a healthcare professional.

Golimumab

A doctor might prescribe golimumab for people who need continuous steroid treatment or for people who have not found other UC medications effective.

In a clinical trial, after 6 weeks, more people who received golimumab than those who did not experienced:

  • a response to the treatment
  • a remission of UC symptoms
  • improvements in the appearance of the intestines on endoscopy imaging

If the body responds to this treatment, a person can keep taking it to maintain remission.

Another trial showed that participants had maintained remission after 30 and 54 weeks of treatment.

A person can self-administer these injections at home after receiving instructions from a healthcare professional.

Infliximab

A doctor might prescribe infliximab if a person with UC did not benefit from other treatments.

Infliximab is the only anti-TNF agent that a doctor can prescribe to children with UC, starting from the age of 6 years.

In clinical studies, adult and pediatric participants experienced remission and healing of the intestinal wall with this treatment.

A doctor might prescribe an integrin receptor antagonist called vedolizumab (Entyvio) for adults with moderate to severe UC.

This drug might be suitable for people with an intolerance to anti-TNF agents or people who did not find these drugs to be effective. It may also benefit people with a dependence on corticosteroids.

Vedolizumab may start to have noticeable benefits after 6 weeks.

In clinical studies, more people in the treatment group achieved remission, after 52 weeks, than those in the control group. In the treatment group, the researchers also found improvements in the appearance of the intestines.

Dosage

The typical dose per infusion is 300 mg. A person will receive their next infusions at 2 and 6 weeks. From then on, they will receive a transfusion every 8 weeks.

Ustekinumab (Stelara) is an antibody that blocks two proteins and signaling molecules called interleukin-12 and interleukin-23.

Both play an important role in the inflammatory and immune responses, and they contribute to chronic inflammation associated with UC.

Ustekinumab is suitable for adults with the condition. It may lead to remission after 8 weeks, and in clinical studies, researchers found that this treatment led to improvements in the appearance of the intestines.

Dosage

For the first dose, a person receives 6 mg for each kilogram that they weigh. The doctor will decide on the best approach after that.

Tofacitinib (Xeljanz) is a biologic that targets Janus kinase, or JAK, proteins to block their activity.

JAK proteins send signals that promote the activity of the immune system. Blocking these proteins stops or slows certain immune functions.

Doctors may prescribe tofacitinib to people with moderate to severe UC that has not responded well to other treatments. People with an intolerance to anti-TNF agents may benefit from this approach.

In one study, 60% of participants who received tofacitinib had improvements in their UC symptoms after 8 weeks. They also experienced less bleeding from their rectums after 2 weeks.

In 7% of participants in the treatment group, researchers observed improvements in the appearance of the intestines, compared with 3% of the placebo group.

Dosage

This drug is available as a pill. A doctor may prescribe 10 mg twice a day for 8 weeks. If the treatment appears to be effective, they may lower the dosage to 5 mg twice a day going forward.

Like all drugs, biologics can cause side effects.

Many of these medications are injected, and at the site of the injection, a person may experience:

  • redness
  • itchiness
  • bruising
  • pain
  • swelling

Other side effects of biologics include:

Side effects of tofacitinib may differ from those of injectable biologics. A person may experience:

Allergic responses can also occur, and they may cause symptoms such as hives and difficulty breathing.

If a side effect is bothersome or might indicate an allergic reaction, contact the doctor. If any side effect is concerning or severe, dial 911 or otherwise contact emergency services.

Before prescribing a biologic, a healthcare professional should describe the risks in detail. Some include:

  • Arthritis: Anti-TNF agents can help treat some causes of joint pain, but they can also cause new joint pain, in some cases.
  • Liver problems: In rare cases, biologics have been linked with liver problems. Anyone who notices yellowing of the eyes or skin while taking these medications should receive medical attention right away.
  • Lupus-like reactions: These reactions to anti-TNF treatment are rare. Stop the treatment and contact a doctor if a rash, joint pain, a fever, or muscle aches develop.
  • Cancer: While the risk is low, researchers have found some associations between anti-TNF agents and lymphoma.

Because biologics affect the immune system, a person taking this type of medication may have an increased risk of infections, some of which can be severe. For this reason, it is important to receive the necessary vaccinations, including those for:

Contact a healthcare professional immediately if a new cough, a fever, or any other flu symptoms develop.

Interactions with other medications

Interactions between biologics and other medications can be significant, and each type of biologic drug can present different risks.

A doctor should be aware of all the over-the-counter or prescription medications, and all the supplements, herbal medications, and vitamins that a person takes before they prescribe a biologic.

Anyone using a biologic for UC should speak with a doctor before receiving a vaccine. For people who use certain biologic medications, including golimumab, infliximab, and adalimumab, having a live vaccine can be dangerous, and doctors recommend avoiding it.

Biologics can be extremely expensive. According to research from 2018, this type of treatment costs $10,000–30,000 per year, on average, and the more expensive types can cost more than $500,000 annually.

A doctor may instead recommend a type of drug called a “biosimilar.” There is very little clinical difference between these drugs and biologics. Biosimilars are less expensive but just as safe and effective.

The Food and Drug Administration (FDA) approved the use of biosimilars in an effort to reduce costs. However, the FDA do not regulate whether insurance companies cover the costs of these drugs.

The following table provides an overview of the biologics available to treat UC. The abbreviation “IV” stands for “intravenous.”

DrugBrand nameType FormSelf-administered?
AdalimumabHumiraAnti-TNFInjectionYes
Adalimumab-attoAmjevitaAnti-TNFInjectionYes
Adalimumab-adbmCyltezoAnti-TNFInjectionYes
GolimumabSimponiAnti-TNFInjectionYes
InfliximabRemicadeAnti-TNFIV infusionNo
Infliximab-abdaRenflexisAnti-TNFIV infusionNo
Infliximab-dyybInflectraAnti-TNFIV infusionNo
Infliximab-qbtxIXIFIAnti-TNFIV infusionNo
VedolizumabEntyvioIntegrin receptor antagonistIV infusionNo
UstekinumabStelaraInterleukin inhibitorIV infusionNo
TofacitinibXeljanzJAK inhibitorPillYes

A range of biologic drugs can reduce UC symptoms in adults and help achieve remission. For children with moderate to severe UC, a doctor may prescribe infliximab.

Biologics are effective because they target the specific factors in the immune system that cause UC.

However, these drugs can cause side effects. It is important to discuss the risks and potential benefits of each option thoroughly with the doctor.