Several classes of biologic drugs are used to treat Crohn’s disease. They all work to reduce inflammation, but they target different parts of the immune system and have slightly different safety profiles.
Anti-TNF Drugs
Anti-tumor necrosis factor (anti-TNF) drugs were the first biologics widely used for Crohn’s disease and have more than 20 years of clinical experience behind them.
“These drugs have the longest track record and work very well for many patients,” Moss says.
But because anti-TNFs suppress immune activity more broadly throughout the body, they may carry a somewhat higher risk of infections.
“For many of my patients, I frame it this way: The older anti-TNF drugs like Remicade and Humira have the longest track record and work well, but they do carry a somewhat higher risk of serious infections, especially when combined with other immune-suppressing medicines,” Moss says.
Anti-TNFs are still commonly used today, particularly for people with fistulizing Crohn’s disease, those who are pregnant, and patients with inflammatory symptoms outside the digestive tract, such as arthritis or skin conditions, Sheth says.
IL-12/23 and IL-23 Inhibitors
Newer biologics, including IL-12/23 and IL-23 inhibitors, target more specific immune pathways involved in Crohn’s disease.
“With newer IL-23 inhibitors like Stelara and Skyrizi, large trials and real-world studies suggest [that there are] fewer serious infections and fewer issues with antibodies,” Moss says. “That means people are often able to stay on them longer without needing to stop or switch.”
Because these medications act more selectively on the immune system, many specialists describe them as having a more gut-focused effect, which may help reduce systemic side effects compared with earlier biologic therapies.
As far as effectiveness, a study published in 2022 compared the TNF inhibitor adalimumab and the IL-12/23 inhibitor ustekinumab and found both biologics equally effective, with comparable rates of remission.
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