Doctors may prescribe biologics to treat ulcerative colitis. Biologics are medications that companies make from living cells.
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.
Biologic medications can be an effective option to help manage UC symptoms, which can worsen during periods known as flare-ups or flares.
Scientists and drug manufacturers make these medications from specially engineered living cells, or antibodies. After growing the cells in a laboratory, scientists extract special proteins and use these to make each drug. These proteins then operate by targeting a particular receptor on immune cells.
Doctors use different biologics to treat a variety of conditions, including cancer and several autoimmune disorders.
The following is a summary of the potential advantages and disadvantages of using biologics to treat UC:
Pros of biologics for UC
Cons of biologics for UC
- can be expensive
- may require injections, which can be challenging or uncomfortable
- may stop working over time
- increase the risk of infection
This article describes the types of biologics that may help treat UC. We also look into their side effects and costs.
In a person with UC, the immune system is overactive and mistakenly attacks healthy cells in the body.
Biologics are medications that attack specific cells and proteins in the immune system that cause inflammatory disease processes. For this reason, doctors also refer to treatment with biologics as targeted therapy.
Usually, a doctor will prescribe biologics to treat moderate to severe UC in adults. There are different types of biologics that may fit a person best depending on their symptoms. These include:
- anti-tumor necrosis factor (anti-TNF) agents
- integrin receptor antagonists
- interleukin inhibitors
- Janus kinase (JAK) inhibitors
Summary of biologic types
The following table provides an overview of biologics available to treat UC. The abbreviation “IV” stands for “intravenous.”
| Drug | Brand name | Type | Form | Self-administered? |
|---|---|---|---|---|
| adalimumab | Humira | anti-TNF | injection | yes |
| adalimumab-atto | Amjevita | anti-TNF | injection | yes |
| adalimumab-adbm | Cyltezo | anti-TNF | injection | yes |
| golimumab | Simponi | anti-TNF | injection | yes |
| infliximab | Remicade | anti-TNF | IV infusion | no |
| infliximab-abda | Renflexis | anti-TNF | IV infusion | no |
| infliximab-dyyb | Inflectra | anti-TNF | IV infusion | no |
| infliximab-qbtx | IXIFI | anti-TNF | IV infusion | no |
| vedolizumab | Entyvio | integrin receptor antagonist | IV infusion | no |
| ustekinumab | Stelara | interleukin inhibitor | IV infusion | no |
| risankizumab | Skyrizi | interleukin inhibitor | IV infusion and injection | yes |
| tofacitinib | Xeljanz | JAK inhibitor | pill | yes |
| upadacitinib | Rinvoq | JAK inhibitor | pill | yes |
| filgotinib | Jyseleca | JAK inhibitor | pill | yes |
| ozanimod | Zeposia | S1P receptor modulator | pill | yes |
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 results more quickly.
Types of anti-TNF agents
Different types of anti-TNF agents may help treat UC. These include:
| Generic name | Brand name | Dosage |
|---|---|---|
| adalimumab | Humira | • 4 injections, 160 milligrams (mg) each • 2 weeks later: 2 injections, 80 mg each • From then on: 1 injection, 40 mg, every 2 weeks |
| adalimumab-atto | Amjevita | • 4 injections, 160 mg each • 2 weeks later: 2 injections, 80 mg each • From then on: 1 injection, 40 mg, every 2 weeks |
| adalimumab-adbm | Cyltezo | • 4 injections, 160 mg each • 2 weeks later: 2 injections, 80 mg each • From then on: 1 injection, 40 mg, every 2 weeks |
| golimumab | Simponi | • 2 starter doses • From then on: every 4 weeks |
| infliximab | Remicade | • IV infusion • first three doses at 0, 2, and 6 weeks • From then on: every 8 weeks |
| infliximab-abda | Renflexis | • IV infusion • first three doses at 0, 2, and 6 weeks • From then on: every 8 weeks |
| infliximab-dyyb | Inflectra | • IV infusion • first three doses at 0, 2, and 6 weeks • From then on: every 8 weeks |
| infliximab-qbtx | IXIFI | • IV infusion • first three doses at 0, 2, and 6 weeks • From then on: every 8 weeks |
Adalimumab
A doctor may prescribe adalimumab (Humira) if a person does not respond well to other immune suppressors, such as corticosteroids, azathioprine (Imuran), or 6-mercaptopurine (Purinethol).
A person can self-administer the injections at home after receiving instructions from a healthcare professional.
Golimumab
A doctor may prescribe golimumab (Simponi) for people who need continuous steroid treatment or have not found other UC medications effective.
If a person’s body responds to this treatment, they can keep taking it to maintain remission.
A person can self-administer these injections at home after receiving instructions from a healthcare professional.
Infliximab
A doctor may prescribe infliximab (Remicade) if a person with UC did not benefit from other treatments.
In clinical studies, adult and pediatric participants experienced remission and healing of the intestinal wall with this treatment.
A doctor may prescribe the integrin receptor antagonist vedolizumab (Entyvio) for adults with moderate to severe UC.
This medication can be suitable for people who cannot tolerate anti-TNF agents or have not found them to be effective. It may also benefit people with a dependence on corticosteroids.
Vedolizumab may start to have noticeable benefits after
Dosage
The typical dose per infusion is
Ustekinumab (Stelara) is an antibody that blocks two proteins and signaling molecules: interleukin-12 and interleukin-23.
Both of these proteins play an important role in the inflammatory and immune responses and contribute to chronic inflammation that is associated with UC.
Ustekinumab and risankizumab are suitable for adults with UC. These drugs may lead to remission after 8 weeks. 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 of body weight. The doctor will decide on the best approach after that.
In 2019, tofacitinib (Xeljanz) was the first biologic medication to receive Food and Drug Administration (FDA) approval to treat UC. It targets JAK proteins and blocks their activity. A second JAK inhibitor, upadacitinib (Rinvoq), received approval for treating UC in March 2022.
JAK proteins send signals that promote immune system activity. Blocking these proteins stops or slows certain immune functions.
Doctors may prescribe tofacitinib to treat 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.
Dosage
This drug is available as a pill. A doctor may prescribe 10 mg twice per day for 8 weeks. If the treatment appears to be effective, the doctor may decrease the dosage to 5 mg twice per day.
Medications such as ozanimod attach to lymphocytes and stop them from causing inflammation. Similarly to other biologics, these medications affect the body’s natural immune response, so they can make people more susceptible to infection and other complications.
Dosage
Ozanimod is available as a once-daily tablet. An initial course of treatment may last up to 12 months. After that, healthcare professionals will assess the medication’s effectiveness. Depending on the outcome of this assessment, they may recommend that the person receive another course of the medication or that they discontinue it.
Like all drugs, biologics can cause side effects.
People have to inject many of these medications. At the site of an injection, a person may experience:
- redness
- itchiness
- bruising
- pain
- swelling
Other possible side effects of biologics include:
Side effects of tofacitinib may differ from those of injectable biologics. A person may experience:
- diarrhea
- headache
- high or low blood pressure
Allergic reactions can also occur and may cause symptoms such as hives and difficulty breathing. In rare cases, a person may experience anaphylaxis.
If a side effect is bothersome or may indicate an allergic reaction, a person should contact a doctor. If any side effect is concerning or severe, a person should call 911 or the local emergency number.
Anaphylaxis: Symptoms and what to do
Anaphylaxis is a severe allergic reaction that can be life threatening. The symptoms develop suddenly and include:
- hives
- swelling of the face or mouth
- wheezing
- fast, shallow breathing
- a fast heart rate
- clammy skin
- anxiety or confusion
- dizziness
- vomiting
- blue or white lips
- fainting or loss of consciousness
If someone has these symptoms:
- Check whether they are carrying an epinephrine pen. If they are, follow the instructions on the side of the pen to use it.
- Dial 911 or the number of the nearest emergency department.
- Lay the person down from a standing position. If they have vomited, turn them onto their side.
- Stay with them until the emergency services arrive.
Some people may need more than one epinephrine injection. If the symptoms do not improve in 5–15 minutes, or they come back, use a second pen if the person has one.
Before prescribing a biologic, a healthcare professional should describe the risks in detail. These risks 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 links to liver problems. Anyone who notices yellowing of the eyes or skin while taking these medications should seek medical attention right away.
- Lupus-like reactions: These reactions to anti-TNF treatment are rare. A person should stop the treatment and contact a doctor if they develop a rash, joint pain, fever, or muscle aches.
- 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 for a person to receive the necessary vaccinations, including those for the following conditions:
A person should contact a healthcare professional immediately if they develop a new cough, a fever, or any other flu symptoms.
Interactions with other medications
Interactions between biologics and other medications can be significant, and each type of biologic drug can present different risks.
Before prescribing a biologic, a doctor should be aware of all the over-the-counter or prescription medications a person takes, as well as all supplements, herbal products, and vitamins.
Anyone who is using a biologic for UC should talk with a doctor before receiving a vaccine. For people who use certain biologic medications, including golimumab, infliximab, and adalimumab, receiving a live vaccine can be dangerous, and doctors recommend avoiding it.
Biologics can be expensive. According to research from 2018, this type of treatment costs
Although many medical insurance plans may cover biologics, the cost can still be high, depending on a person’s deductible.
A doctor may instead recommend a biosimilar medication. There is
The FDA approved the use of biosimilars in an effort to reduce costs. However, the FDA does not regulate whether insurance companies cover the costs of these drugs.
Below, we answer some questions that people often ask about biologics for UC.
How long do you take biologics for ulcerative colitis?
A person may feel better after 6 to 8 weeks of taking biologics, although some drugs can take longer to be effective. When considering whether to stop taking a biologic, a person should consult their doctor to discuss factors such as their current symptom level, any medication side effects, and any other health conditions they have.
Which biologic is safest for ulcerative colitis?
According to a 2020 research review, vedolizumab comes with the lowest risk of infection, followed by ustekinumab.
Do biologics make you gain weight?
Some biologic medications that doctors use to treat UC
A range of biologic drugs can reduce UC symptoms in adults and help bring the condition into remission. To treat moderate to severe UC in children, 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 a doctor.