Biologic therapies have been hailed as a major advance in the treatment of Crohn’s disease. They offer a more targeted approach and can be very safe and effective. In fact, they may have fewer side effects than some other medications for Crohn’s disease. For instance, unlike corticosteroids that work by suppressing the entire immune system, biologics target specific proteins in the immune system that are associated with inflammation. Taking biologics is more complicated than swallowing a pill though, and they pose different health risks than other Crohn’s disease medications. To make the most informed decision, talk to your doctor about biologics. Each person with Crohn’s disease is different, so the conversation will be specific to your condition and concerns. The answers may even be different for you than other people who have the disease. Use these questions to start a dialogue with your doctor:
1. Why do you think biologics will work for my Crohn’s disease?
To achieve remission, the right Crohn’s disease treatment choice depends on the severity of your disease. Understanding why biologics are the next step in your treatment plan can give you a better perspective on your condition. For instance, your doctor might recommend biologic drugs to treat your Crohn’s disease because you aren’t responding well enough to other drugs. Or, it could be that the targeted nature of a biologic medication will bring you relief with fewer side effects. Although biologics are generally recommended for people with moderate to severe Crohn’s disease, it’s important not to wait until it’s too late to use biologics. That’s because these medications can lose some of their effectiveness in people with advanced cases of the disease, says Terilyn Scott-Winful, MD, a gastroenterologist with Baylor Scott and White Health in Plano, Texas. “You don’t have to wait for the disease to be so severe to use biologics,” she says. “You have to stay one step ahead of disease.” Ask why your doctor thinks biologics may be the best option for you and discuss your expectations about your short- and long-term Crohn’s disease treatment plan. Dr. Scott-Winful says that biologics have been safely used by millions of people for more than 15 years now and that the risks may be exaggerated, adding that sometimes people focus on the very rare but serious events rather than the day-to-day benefits, such as fewer Crohn’s disease flares. It’s important to have this discussion with your doctor to weigh the risks and benefits considering your full health profile.
3. How will a biologic drug be administered?
Biologic drugs are available only by intravenous (IV) infusions at a medical facility or by injection that you or someone else can give at home. If you’re uncomfortable with this process, an IV infusion might be a better choice. On the other hand, infusions tend to take a couple of hours each time, which might be more taxing on your schedule. Keep in mind that consideration for the method of delivery of the drug is secondary to which biologic medication is more likely to help your Crohn’s disease.
4. How often will I get the biologic drug?
Each biologic medication has a different treatment schedule, which ranges from every two weeks to every two months, so you’ll want to find out the specifics first. Also ask about any frequency differences between initial and ongoing treatment schedules to treat flares and to induce and maintain remission.
5. How long can I expect the biologic drug to be effective?
“There’s a small amount of loss of response to the drug over time,” Scott-Winful says. Make sure you understand what will happen if the biologic medication you’re taking loses effectiveness and how your doctor may alter your treatment regimen or will recommend switching drugs. Ask your doctor what kind of effect you can expect from the drug in the short- and long-term and what alternative options are available.
6. How expensive are biologic drugs?
Depending on the drug and how frequently you need treatment, the cost of biologics can range from about $1,100 to more than $5,000, averaging about $2,000 per infusion or injection, according to research published in BMJ Open Gastroenterology in 2016. A cheaper option may be biosimilars, which were approved by the Food and Drug Administration for Crohn’s treatment. (Think of them as generic versions of biologics, which can be less expensive.) Infliximab-dyyb is an infliximab biosimilar, and adalimumab-atto is a biosimilar to adalimumab. Talk to your doctor about the differences between these drug classes. If your insurance doesn’t cover treatment with biologics, ask your doctor whether there are other payment options available; for example, you may be a candidate for an assistance program offered by drug companies and other organizations.
7. What side effects might I experience from taking a biologic drug?
Although biologics have fewer side effects than other Crohn’s disease drugs, you still need to know what side effects to expect and how you can manage them. For example, pain, itching, bruising, and redness at the injection site are common, according to the CCFA. Headache, nausea, fever, chills, and hives are other possible complications. Ask your doctor if there are specific side effects associated with the particular biologic medication your doctor is recommending for you and when to call his or her office if side effects occur.
8. Are there other biologic drug options in the pipeline that might work for me?
In 2016, in addition to approving biosimilars for Crohn’s, the FDA approved ustekinumab, a biologic that targets IL-12 and IL-23, proteins involved in inflammation, and has been used for psoriasis. There are also several new biologic therapies under investigation for the treatment of Crohn’s disease, as well as new types of oral drugs that target key parts of the intestines. If one of these drugs holds more promise for you, you may be eligible to participate in a clinical trial. If your Crohn’s disease is currently well-controlled, your doctor may recommend waiting until newer drug options become available to start biologic treatment. Additional reporting by Diana K. Rodriguez and Julie Stewart
