Biologics for Ulcerative Colitis: All You Need to Know

As reported by the EFCCA, approximately 10 million people across the globe are living with some type of Inflammatory Bowel Disease (IBD). Ulcerative Colitis (UC) is a form of IBD that targets the digestive tract and leads to inflammation. It can worsen during phases of flare-ups and there are different options for treatments.

Biologics for Ulcerative Colitis are an effective method for managing the symptoms of Ulcerative Colitis. These are a few of the tested and approved targeted therapies for UC and are special-engineered drugs that target certain receptors of the immune cells. Different types of biologics are used for IBD, cancer, and other autoimmune disorders.

This article will give a complete overview of biologics for Ulcerative Colitis, their efficacy in treating the condition, and things you should know before undergoing the treatment.

What to Expect if You Have Ulcerative Colitis?

While Ulcerative Colitis affects the gut, it primarily produces inflammation in the lining of the colon, eventually developing ulcers. This can spread to the rectum and lower part of the large intestine and the sores often cause intense diarrhea and bleeding.

Treatments for UC are usually aimed at managing the symptoms of the condition and tackling the flare-ups, however, only surgical methods of removing the colon can fully cure this disease. Biologics for UC can effectively treat the disease and most people can live a normal life while undergoing this treatment.

If you have been diagnosed with Ulcerative Colitis, here are some of the common classifications of this condition:

Remission: If you don’t have any serious discomfort and pain, and are having around 2-3 solid bowel movements per day, this phase is probably clinical remission.
Mild to Moderate: Ulcerative Colitis is a progressive disease. Your symptoms can get worse slowly and build up over time.
Severe: If you spot blood in your stools and are having more than six painful bowel movements every day, your condition is most likely severe. You can also experience other issues like pacing heart rate and fever.
Toxic: This is the last stage of Ulcerative Colitis. Patients at this point experience more than ten bowel movements per day, rectal bleeding, fever, nausea, and other symptoms. Toxic colitis needs to be tackled as soon as possible.

List of Biologics For Ulcerative Colitis

Biologics are a relatively new treatment for managing Ulcerative Colitis. By growing laboratory cells, special proteins are extracted from each cell. The manufactured antibodies are utilized in the development of biologics. These drugs aim to restrict the working of certain inflammatory proteins in the body.

Since these drugs are a type of targeted therapy, they affect particular areas rather than the entire body. Three different groups of biologics for UC are approved to be used as a treatment for this condition. These groups are divided according to the protein they target:

Anti-tumor necrosis factor (anti-TNF) agents

Anti-TNF agents target the tumor necrosis factor-alpha (TNF-alpha) protein. This type of biologics binds and restricts the protein from causing inflammation in organs, intestines, and tissues. While these drugs can help you maintain remission, in some cases it can also help heal the intestines.

Some of the common types of Anti-TNF agents are:

Infliximab (Remicade): Treats moderate to severe Ulcerative Colitis. It is taken through infusion in the veins and the process can take about 2 hours. Multiple doses of Infliximab are usually prescribed.
Golimumab (Simponi): This is injected to treat Ulcerative Colitis in patients who were previously on steroids and struggle with leaving them. While a health expert administers its doses, multiple injections are prescribed across a couple of weeks.
Adalimumab (Humira): This is a prescription medication and is usually injected into the muscles of the thigh or the abdomen. It is most effective for people with moderate to severe Ulcerative Colitis. Although you can administer this at home, consulting a doctor for the right and timed doses is important.

Integrin receptor antagonists (IRAs)

For people whose bodies have not responded well to other medications, IRAs prove to be beneficial. These block the proteins found in inflammatory cells, which restricts them from moving into the bloodstream and other tissues.

Vedolizumab (Entyvio) is a commonly used IRA that is prescribed as an intravenous (IV) medication. The process of infusion takes approximately 30 minutes and the following doses are prescribed over 8 weeks.

Interleukin (IL) inhibitors

This biologic targets proteins that cause inflammations like interleukin-12 and interleukin-23. This drug is usually prescribed to those suffering from moderate to severe UC, and not responding to other treatments. The first dose is administered through an IV infusion, while the rest are maintenance injections that are taken every 8 weeks.

How Are Biologics Administered?

Unlike conventional medical treatments, biologics for Ulcerative Colitis are not taken orally. They are administered through two methods, intravenous infusion and subcutaneous injection. While some of the biologics are delivered completely through infusion, others can be administered in a mixture of ways.

The two main methods of administering biologics are:

Biologic Intravenous Infusion

Infusions are mostly administered under the supervision of a health expert, however, depending on the medication, some biologics can also be taken at home. The process of intravenous infusion looks like this:

Pre-Infusion: Pre-infusion checks are done to ensure that the body is fit to receive the medication. These tests can include weight, BP, and any sign of sickness or pain.
IV Setup: Infusion is usually done through the arm, where a small and thin catheter is inserted into the vein. This is connected to an IV bag via an IV line.
Determining The Dose: There are no fixed dosages, and the doctor prescribes the medication according to your condition and severity of Ulcerative Colitis.
Look Out for Allergic Reaction: Once the infusion begins, patients are monitored for any possible allergic reactions. Any signs of nausea, breathing difficulty, and headache should be communicated to the doctor.
Monitoring Vitals: Your vitals will be checked throughout the process.
Post-Infusion Care: After the infusion, be wary of any side effects. Some of the common symptoms include rashes, flare-ups, and headaches.

Subcutaneous Injections

Biologics that are administered through subcutaneous injections can be given as self-injections. These injections come in prefilled syringe devices or pens and a health service provider can help you with the setup. This setup can include travel packs and sharps containers.

Benefits of Taking Biologics For Ulcerative Colitis

According to studies, around 20 to 40% of patients with Ulcerative Colitis do not respond to usual medications like steroids and immunosuppressive drugs. In this case, biologics emerge as unique and targeted treatments. They regulate the immune system and can help manage inflammations.

Here are some of the reasons why biologics for UC are effective:

Can Help Achieve Remission: Research reveals that 53% of patients with Ulcerative Colitis achieved clinical remission within one year of using biologics. This is because these medicines can curtail inflammation, and also heal the colon in cases of mild symptoms.
Quick Response: Biologics are particularly effective in managing flare-ups. While flare-ups can last a long time, biologics bring about fast relief and results.
Manageable Side Effects: Although biologics are not free of risks, they have fewer long-term side effects compared to steroids. This is because rather than impacting the entire body, biologics only impact targeted areas.
Do Not Interfere With Your Routine Life: While other medications like immunosuppressants, aminosalicylates, and steroids are prescribed for daily intake, biologics are more structured in terms of doses. They are injected or infused, compared to other drugs that are either taken orally or rectally.
Can Delay Surgery: In extreme cases of Ulcerative Colitis, surgeries like proctocolectomy become essential. However, research shows that taking biologics can eliminate or delay the need for serious surgery.
Effective Option For Treatment: If your body is not responding to usual medications, biologics can help you achieve remission and get treated safely.

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What Are the Risks of Taking Biologics

Although biologics for Ulcerative Colitis are very effective, there are some risks and side effects involved. Here is a breakdown of things you should be aware of before opting for this treatment:

Infections: Since the immune system is compromised while taking biologics, patients are prone to the risks of infections. These commonly include influenza, pneumonia, and hepatitis. Getting vaccinated in time is necessary for safety.
Arthritis: Biologics, particularly anti-TNF agents can contribute to new joint pains.
Lupus-like Reactions: If you observe rash, joint pain, muscle aches, and fever while taking anti-TNF agents, consult a doctor to check for possible Lupus-like reactions.
Liver Problems: Although rare, but some people’s bodies can react negatively to biologics. If you notice yellowing eyes and skin, check with a doctor immediately to rule out any problems with the liver.
Cancer: Although the probability is very low, long-term use of biologics can contribute to the development of cancer.

How to Choose the Right Treatment for Ulcerative Colitis

Undergoing a treatment for Ulcerative Colitis can be tolling. Different treatments can help you control your symptoms and flare-ups, however, choosing the right fit for your body is extremely important.

While planning your treatment with a doctor, here are some of the things that you should consider:

Severity

If your bowel movements per day range between 3-6, you are experiencing mild to moderate Ulcerative Colitis. Anything more can be a sign of severe colitis which needs immediate assistance as symptoms can quickly worsen with time.

For mild to moderate Ulcerative Colitis, Aminosalicylates are usually the first line of choice to reduce inflammation. However, with stronger symptoms like blood spots in stools, other drugs might be prescribed.

Location of Affected Area

Although Ulcerative Colitis is localized to the colon, it can spread to the rectum. For diagnosis, the doctor might insert a viewing tube through the colon to find the affected areas. Two of the common diagnoses include distal colitis which impacts the rectum and goes to the colon bend near the spleen. The other diagnosis is extensive colitis where the entire rectum and colon are inflamed.

Distal Colitis is a less severe type of UC and rectal foams, enema and suppositories can effectively cure it with minimum side effects. On the other hand, any form of extensive colitis needs more advanced treatments that go up to the colon lining.

Activity of Ulcerative Colitis

Active UC can often lead to phases of flare-ups, whereas a symptom-free phase characterizes remission. The types of medication can vary according to this activity and the doses can fluctuate. For example, steroids are prescribed to manage severe flare-ups, but long-term use can prove hazardous. On the other hand, biologics for Ulcerative Colitis are taken over a longer course of time for a more permanent solution to inflammation.

Effectiveness of Other Treatments

Your doctor will evaluate your existing history of other treatments. The effectiveness or lack of response can help determine the way forward with future treatments. For instance, if aminosalicylates and corticosteroids have not created a significant impact on your condition, you might get other medications prescribed.

There is a list of biologics for Ulcerative Colitis including infliximab (Remicade), Golimumab (Simponi), vedolizumab (Entyvio), and adalimumab (Humira). These biologics are target-specific and can significantly improve inflammations. However, if your doctor concludes that your body is not responding well to medicinal treatments, surgery to remove the colon, a part of the colon, or the rectum might be advised.

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Cost Effectiveness of Biologics For Ulcerative Colitis

If you are opting for biologics as a treatment for Ulcerative Colitis, it is important to be aware of the cost. These medications can prove to be expensive so you should take your budget into account before undertaking the treatment.

Here is a breakdown of cost-related factors to consider:

Look For Insurance Coverage: Different health insurance companies offer coverage of biological drugs and various financial assistance programs. Before undergoing treatment with biologics, it is important to look for financial support.
Biologics Can Be Expensive: This expensive treatment ranges from an average of $10,000 to $30,000 per year. Depending on the type of medication, the price can also increase up to $500,000 every year.
Explore Cheaper Options: If you are on a budget, biosimilars are effective alternatives for biologics. Although they are not the exact copies of biologics, they prove to be equally effective, however cheaper. Inflectra and Amjevita are a few of the FDA-approved biosimilars.

Managing an Ulcerative Colitis Flareup

Ulcerative Colitis is a fluctuating disease and the severity of symptoms can vary. Even if you are taking biologics for UC, you might experience flare-ups. Here are a few tips that can help you manage these symptoms for a better quality of life:

Focus on What You Eat

Your diet during a flare-up plays a significant role in the severity of the episode. If you are taking fruits and vegetables, ensure that they are well-cooked and do not complicate your digestive process. Similarly, avoid caffeine and greasy foods that can further cause inflammation in your colon. Instead, drink plenty of water and fresh fruit juices to soothe your symptoms.

Manage Your Stress

Flare-ups can increase stress, which can trigger your symptoms even more. Look for ways to manage stress including breathing exercises, yoga, or any hobby that can help you feel relaxed. Staying calm can also help you avoid triggers, and have a more effective treatment.

Consider over-the-counter medications

During an episode of flare-up, your diarrhea and nausea can get worse. Check with your doctor to find the emergency medication that can help you during a flareup. Some of the commonly prescribed drugs include Tylenol for Ulcerative Colitis pain and Pepto-Bismol for heavy diarrhea.

Plan Ahead

If you are traveling, it is crucial to know where the restrooms are and carry an emergency kit in case of flare-ups. You should also maintain a note of your symptoms and how your body is reacting. This will help you recognize an upcoming flare-up, avoid any untimely accidents, and save you from the hassle of cleaning up in an unknown place.

Get Support

Getting support and help with your condition will not eliminate your symptoms, but it will make the management of your disease easier. You can confide in family or friends about flare-ups, what you need, and how they can help you cope with it better. They can also assist you in finding restrooms, accompanying you, and providing moral support. Build a network for yourself, or join an Ulcerative Colitis support group to find people who can relate to your struggles.

Take Probiotics

Your flare-up might be a result of your body reacting to antibiotics. Consult a doctor about this and find sources of probiotics like yogurt to help maintain a healthy gut.

Soothe the Burn

If you are dealing with severe Ulcerative Colitis, constant diarrhea can cause anal infection and irritation. This can worsen during a flare up and you can tackle this by taking warm salt baths frequently. You should also consult a doctor for protective ointments to help with the burning sensation and possible rashes.

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Frequently Asked Questions

What is the duration of taking biologics for Ulcerative Colitis?

The effectiveness of biologics depends on your condition and the medication prescribed. However, most of the treatments with biologics last around 6 to 8 weeks.

What are the side effects of biologics for Ulcerative Colitis?

The most commonly experienced side effects of biologics are rashes, redness, painful lumps under the skin, and itching. In the cases of severe allergic reactions, patients can also experience fever, sore throats, nausea, and headaches.

Do biologics weaken the immune system?

Since biologics mostly impact your immune cells, they can weaken your immune system, impacting your body’s ability to fight other infections as well.

Key Takeaways

Biologics for Ulcerative Colitis are an effective method of treatment.
If you are diagnosed with Ulcerative Colitis, your condition can be classified as remission, mild to moderate UC, severe UC, or toxic UC.
There are three different types of FDA-approved biologics. These include anti-TNF agents, IRAs, and Interleukin (IL) inhibitors.
Biologics are administered through two different methods; Biologic Intravenous Infusion and Subcutaneous Injections. The choice of administration depends on the type of biologic.
Biologics help with remission, produce a fast response, come with manageable side effects, do not interfere with your routine, help delay surgery, and are effective.
There are different risks of taking biologics, which include infections, the risk of arthritis, lupus-like reactions, issues with the liver, and the possibility of cancer.
When thinking about the cost of biologics, it is important to consider insurance coverage, availability of biosimilars, and your budget.
While choosing the right treatment for your condition, it is important to consider the severity of symptoms, affected area, activity of UC, and response to other treatments.
Focusing on your diet, managing your stress, taking medicines, planning ahead, and getting support are some of the tips to manage flare-ups.

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Biologics for Ulcerative Colitis: All You Need to Know

Table of Contents

What to Expect if You Have Ulcerative Colitis?

List of Biologics For Ulcerative Colitis