Should You Consider Stacking Biologics for Ulcerative Colitis?
Your gastroenterologist will take several factors into account before they recommend combining advanced therapies. “Disease severity, multiple prior biologic failures, and concurrent extraintestinal manifestations or other immune-related diseases are all considered when deciding to initiate dual [advanced] treatment,” says Nguyen.
When Your Ulcerative Colitis Hasn’t Responded Well to Treatment
“Patients with long-standing, hard-to-manage disease rise to the top,” says Dr. Bickston. This means if other treatments haven’t worked well to decrease UC symptoms and promote intestinal healing, dual therapy may be a potential next step.
When Surgery Isn’t an Option
Some people have surgery to remove the part of their colon affected by UC, or the whole colon. “But not all patients want surgery,” says Bickston. “Some also have conditions that make them unfit for surgery, so maximizing medical therapy is vital.” In these cases, biologic stacking may be a good option.
When You’re Having Symptoms Outside Your Colon
Dual therapy may also work well for people who have extraintestinal manifestations of UC — symptoms that affect areas of the body outside the colon. These complications can include symptoms or conditions that affect the joints, skin, eyes, blood, and bones, as well as organs like your kidneys and liver.
Whether You’re Able to Access the Medication
Even if you’re a good candidate for dual biologic therapy, expense can be a barrier. Nearly all insurance providers require proof that you have tried other UC treatments that failed before they will approve a biologic therapy at all, much less two.
Biologic medications are expensive in the United States — they can cost many thousands of dollars per year. And many insurance companies haven’t updated their clinical guidelines in years, so they may not represent current standards of care. To find out if your insurer will cover the cost of two advanced therapies, you can check your coverage details or call their customer service number to find out what they require for coverage.
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