3. Biologics Are Given by Injection, Infusion, or Both
Biologic therapies are given either as a subcutaneous injection (a shot under the skin) or an intravenous (IV) infusion (through a vein). The method and frequency depend on the specific drug:
- At-Home Injections Some biologics are taken only as a shot, which you or a loved one can learn to administer at home. After the initial “starter dose,” these are typically taken every two to four weeks. Examples include adalimumab (Humira) and golimumab (Simponi).
- Combined At-Home and IV Infusion Many newer biologics, including ustekinumab (Stelara), risankizumab (Skyrizi), and mirikizumab (Omvoh), use a two-step approach. You receive a single starter dose through a one-time IV infusion, and all subsequent maintenance doses are administered as at-home shots. Depending on the drug, these shots are taken every four to eight weeks.
- Choice of Infusion or Injection Some drugs offer more flexibility for maintenance therapy. For example, after induction, vedolizumab (Entyvio) can be taken as either a 30-minute IV infusion every eight weeks or as an at-home shot every two weeks. Similarly, infliximab (Remicade) is available as either an IV infusion or a subcutaneous shot for maintenance.
4. Biologics May Be Used in Combination With Other UC Medications
“A biologic medication combined with a traditional ulcerative colitis drug may work better than either drug alone,” Dr. Ullman says, but two biologics shouldn’t be taken together because of an increased risk of complications.
A common strategy is to pair an anti-TNF biologic with an immunomodulator. This can help the biologic work more effectively and reduce the likelihood of your body developing antibodies against it.
5. Biologics May Take Time to Work
When you start taking an anti-TNF drug, it may take up to eight weeks before you notice any improvement in your UC symptoms. While some people notice an immediate improvement, the possibility of a delayed effect means you’ll need to continue your treatment for several weeks before you determine it isn’t effective.
6. You May Need to Change Your Dose or Try Different Biologics
If a biologic drug isn’t providing enough relief, it doesn’t mean you’re out of options. Your doctor may first try to adjust your treatment by increasing the dose or having you take it more frequently.
If that doesn’t work, the next step is often switching to a different medication. For example, if you don’t have success with an anti-TNF biologic, drugs like ustekinumab (Stelara) or certain Janus kinase (JAK) inhibitors like tofacitinib (Xeljanz) or upadacitinib (Rinvoq) may be recommended over other options. Ultimately, choosing your next medication is a personal decision that you and your doctor will make together based on your health history and treatment goals.
7. Biologic Therapy Can Lead to Long Periods of Remission
Biologics are effective for both inducing and maintaining remission in people with moderate to severe UC. “We’re seeing fewer hospital admissions, fewer surgeries, and less disability from ulcerative colitis with the use of these drugs,” says Ullman.
8. Biologics May Become Less Effective Over Time
It’s possible for a biologic medication that initially worked well for you to become less effective over months or years. This is known as a loss of response, and it’s a known challenge in the long-term management of UC.
If this happens, you have options. According to treatment guidelines, if you lose response to an anti-TNF drug, the preferred next step is often to switch to a drug from a different class with higher or intermediate efficacy.
9. Biologics Have Some Side Effects and Long-Term Risks
Common side effects of biologic drugs often relate to how they’re given. You may experience injection site reactions, including itching, rashes, or swelling.
10. Biologics Are Expensive
Biologic drugs can be very expensive. While health insurance covers a portion of the cost, out-of-pocket expenses can still be a major consideration. It’s important to talk with your insurance provider and your doctor’s office to understand what you can expect to pay.
“In most cases, insurance companies do cover biologics, and most drug companies offer financial assistance programs to help cover the cost,” Ullman says.
To help manage costs, a growing number of “biosimilar” drugs are now available. According to the U.S. Food and Drug Administration (FDA), a biosimilar is a biologic that’s similar to an existing, FDA-approved biologic. There are no clinically meaningful differences between biologics and biosimilars in terms of safety and efficacy.
Today, multiple FDA-approved biosimilars are available for many of the most common biologics used for UC, including infliximab and adalimumab.
The Takeaway
- For people with moderate to severe ulcerative colitis that hasn’t responded to other medications, biologic drugs offer a targeted way to control the underlying inflammation and lead to long-term remission.
- There are many different types of biologics that work in different ways, and it can take up to two months or more to feel the full effects of a new treatment.
- If one biologic becomes less effective over time, guidelines now provide a clear strategy for switching to a different medication that may work better for you.
- Because these drugs affect your immune system, they have some side effects and risks, most notably an increased susceptibility to infection. Be sure to discuss the specific benefits and risks of each option with your doctor to make a shared decision about your care.
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