Biologic Treatments: what to expect

Whether you’re newly diagnosed or have been suffering with Crohn’s or Ulcerative Colitis for years, your doctor may suggest biologic medications (also known as Biologics) to treat your disease. Biologics are used in patients with moderate to severe Inflammatory Bowel Disease (IBD) when other treatments have not worked, or side effects have been difficult to manage.

What are biologics?

Biologic are used to treat IBD because they help the immune system target certain proteins that cause inflammation. They work by blocking chemical messages from the immune system that trigger inflammatory events in people with IBD.

Biologic treatments have been shown to be very safe and effective in improving gut symptoms, preventing flares and inducing and maintaining remission.  These medications have become the standard of care for people with moderate to severe IBD. Making the decision about your treatment should be done after full discussion with your IBD specialist and IBD Nurse.

What are the biologic medications available?

There are currently 5 main biologics used in Australia:

• Infliximab (Remicade®)
• Adalimumab (Humira®)
• Vedolizumab (Entyvio®)
• Golimumab (Simponi®)
• Ustekinumab (Stelara®)

Not all drugs are used to treat both Crohn’s Disease and Ulcerative colitis. You can read more about what each of these do in our blog about newer and emerging IBD treatments.

Are there any side effects?

As with any medication there are always possible side effects. The possible side effects will depend on which biologic you are on, but include:

• Infusion/injection site reaction
• Bacterial infections
• Infections of the respiratory, urinary tract or gastrointestinal tract

Your gastroenterologist will discuss any side effects with you before you commence treatment and weigh up the benefit of the treatment versus any possible side effects.

How are biologics given?

There are two main ways that biologics are delivered to patients – by intravenous infusion and by subcutaneous injection (under the skin). Some are available as infusion only, some by injection only and some start as infusions for the first few treatments, then continue via injection.

Biologic infusions

Biologic intravenous infusions are generally given at day hospitals or in the home (depending on the biologic medication).  If your infusion is happening in a Day Hospital setting the nurse will do some pre infusion checks, which could include weight, pain and any sickness, you will be seated in comfortable chair and a nurse will setup the IV. Normally done in the arm, this involves inserting a small, thin catheter into a vein. Your medication, in an IV bag or bottle, will be connected to the IV line. The dosage will be determined by your doctor and will depend on factors such as which type of IBD you have, how severe your disease is and your weight.

After the medication is connected the nurse will start the infusion and monitor you for signs for allergic reaction. Let them know if you have any issues, such as difficulty breathing, nausea or headache. They will check your vital signs (Blood pressure, pulse and respiratory rate) throughout the infusion, which could take anywhere from 30 minutes to a few hours. Bring a book, your tablet or laptop to keep you busy while you wait (or just use the time to sleep if you can). The main source of discomfort should be from the insertion of the catheter itself, as most people don’t feel anything as the medicine comes through.

Once the infusion is complete you may be required to stay a little longer to ensure there are no other side effects. You should also monitor for side effects at home and contact your gastroenterologist right away if you notice severe headaches, rashes or sudden worsening of your symptoms.

Subcutaneous injections

Biologics via subcutaneous injection can be given as a self-injection. These are generally prefilled pen or syringe devices. You will be contacted by a support service that assists with the first injection in your home and provides all the accessories you need such as sharps container and travel packs. With their training and guidance, you will be able to inject subsequent doses yourself.

It’s ok to be uncertain if this is the first time you’ve had biologics. Your treating team will explain why they are using biologics and help alleviate any anxiety you may have.

IBD SA have Biologic information sheets that can be given to you at your appointment or emailed to you. The IBD Nurse Specialists at IBD SA are available to answer your questions about Biologic treatment options Monday – Friday 9-5pm on (08) 8100 0736