Biologic treatments in IBD

A targeted treatment that acts on the inflammation pathway in Crohn's disease and ulcerative colitis

• Targeted treatment
• Regular follow-up
• Shared decision

A precise treatment that targets inflammation

What are biologic treatments?

Medicines made using advanced biotechnology. Most are antibodies designed to target a specific substance or cell that causes inflammation in the bowel.

They are not steroids or painkillers; they are a treatment that aims to calm inflammation over the long term.

Three main ways to calm inflammation

How do they work?

• Blocking the inflammatory substance 'tumour necrosis factor' (TNF) — for example: infliximab, adalimumab, and golimumab (for ulcerative colitis only)
• Stopping inflammatory cells from reaching the bowel wall — for example: vedolizumab
• Blocking the 'interleukin' signals that drive inflammation — for example: ustekinumab, risankizumab, mirikizumab, guselkumab

Your doctor chooses the right type based on the type and severity of your disease, your previous treatments, and your general health.

When is biologic treatment recommended?

When do we use them?

• Moderately or severely active disease
• Not responding well enough to other treatments — or symptoms returning whenever the steroid dose is reduced
• Signs that predict a more severe course of disease — such as a fistula around the back passage (anus), extensive disease, or diagnosis at a young age
• Keeping the disease calm and preventing complications — it is a long-term treatment, not just for a short period

In some cases, biologic treatment is started early, without waiting for other treatments to fail.

Two ways to give the treatment

How is it given?

• Infusion into a vein (drip) — in the hospital day-treatment unit; it usually takes from half an hour to two hours
• Injection under the skin — with a ready-to-use pen or syringe that the patient learns to use at home

Treatment starts with starter (induction) doses given close together, followed by regular maintenance doses. Some treatments start in a vein and then continue as injections under the skin.

Essential tests before the first dose

Before starting

• Test for latent (hidden) tuberculosis (TB) — with a blood test or skin test, plus a chest X-ray if needed
• Test for viral hepatitis B and C — and HIV, depending on your doctor's assessment
• Review and complete your vaccinations — because live vaccines are not usually given during treatment
• Baseline blood tests — full blood count and liver and kidney function

Tell your doctor about any pregnancy or plans for pregnancy, any previous TB infection, or repeated infections.

Your safety during treatment

During treatment

• Watch for signs of infection — such as fever or a persistent cough, and contact the clinic early
• Regular blood tests and follow-up — to monitor your response to treatment and make sure it is safe
• Do not stop treatment on your own — the disease may become active again and the medicine may work less well later
• Tell any doctor who treats you — that you are on a biologic treatment, including your dentist, especially before any operation or vaccination

Serious side effects are uncommon. Your doctor weighs the benefits and risks of treatment against the risks of the disease staying active without proper treatment.

Biologic treatment: the summary

Key messages

• A targeted treatment that precisely acts on the inflammation pathway
• The right type is chosen for each patient after a full assessment
• Tests before starting are an essential part of your safety
• Keeping to appointments and doses keeps the treatment effective
• Regular follow-up is necessary even when symptoms improve

Contact the clinic if you have:

• A high temperature or symptoms of infection
• Diarrhoea, blood or pain coming back
• Plans for pregnancy or for any operation
• A skin rash or swelling after a dose
• A delayed or missed dose
• A need for any vaccination

If you have difficulty breathing, swelling of the face or any emergency, go straight to the nearest emergency department.