1. Get the Right Safety Screenings Before Your First Dose One of the first steps before starting a biologic for Crohn’s disease is getting an infection screening. Because biologics suppress parts of the immune system, doctors need to make sure there are no hidden infections or other health issues that could become more dangerous once treatment begins, says Alan Moss, MD , chief scientific officer at the Crohn’s & Colitis Foundation and a professor of gastroenterology at Boston University’s Chobanian & Avedisian School of Medicine. “Before starting biologic therapy, we routinely screen for infections such as tuberculosis, hepatitis B and often C, and, depending on history and risk factors, sometimes HIV and other latent infections. This step is key because biologics can allow silent infections to reactivate and become serious,” Dr. Moss says. “If these screenings identify a possible infection, then getting that evaluated further and treated if needed is really important, so that it doesn’t worsen when the immune system is weakened and may not be able to fight off the infection on its own,” says Michelle Becker, PharmD , a spokesperson for the American Gastroenterological Association and a clinic-based pharmacist specializing in working with patients with IBD. Your doctor may also check for underlying health conditions, including:e60dc2a1-f33c-4a05-9b50-8e3e8e5976296ca3e00a-19b9-48de-8fc7-e697bd82d6b3 Cervical cancer Colon cancer Skin cancer Mental health conditions, such as depression Osteoporosis Screening may also include checks for patient-specific risk factors, as well as other issues such as liver function, heart failure, or multiple sclerosis, says Becker.
For many people living with Crohn’s disease, starting a biologic can feel like a turning point. These medications, which are lab-made antibodies that target specific immune system proteins, have transformed care, helping many patients with an inflammatory bowel disease (IBD) such as Crohn’s ease symptoms, heal chronic inflammation, and achieve remission.e60dc2a1-f33c-4a05-9b50-8e3e8e59762930da8654-04db-456d-8903-0d00b97551c7 But deciding to begin a biologic isn’t as simple as picking up a prescription and hoping for the best. There’s a lot to think through first: what safety screenings are needed, how the drug will fit into everyday life, and what kind of follow-up will happen after treatment starts. Preparation, including knowing what to consider and what to expect, can make the transition feel much more manageable. That’s why a pre-biologic checklist can help. Here are six important things to discuss with your IBD care team before starting a biologic for Crohn’s disease.
Resources We Trust Cleveland Clinic: Biologics (Biologic Medicine)Mayo Clinic: Crohn’s DiseaseCrohn’s & Colitis Foundation: Medication Options for Crohn’s DiseaseUniversity of Chicago Medicine: Biologics and Inflammatory Bowel Disease (IBD)Crohn’s & Colitis Foundation: IBD and Keeping Up With Immunization
6. Make Sure the Treatment Fits Into Your Daily Life Biologics are long-term therapies, so how they fit into your routine matters just as much as how well they work.e60dc2a1-f33c-4a05-9b50-8e3e8e5976298b20c183-6587-43af-b1cf-02d782473cfb “For most people, biologics become part of the routine of life, either a scheduled self-injection at home or periodic infusions at a clinic, rather than something that dominates every day. When biologics are effective, many patients find that improved symptom control, more energy, and fewer flares actually give them more freedom at work, school, and in social and family life,” Moss says. The goal is for treatment to be as seamless as possible, Sheth says. Talk to your doctor about your preferences, professional life, and other commitments to ensure that your treatment plan fits into your schedule. Many medications are now taken at home, either as injections that take just a minute or two or, in some cases, as oral pills, he says.e60dc2a1-f33c-4a05-9b50-8e3e8e5976294bfb6c32-689b-4d15-b7ca-5763f7081f6c Because many biologics aren’t taken daily, they can be easier to forget. Becker recommends setting up a system early on, like a calendar, an app, or other reminders to keep track of doses, refills, infusion appointments, lab work, and vaccines.e60dc2a1-f33c-4a05-9b50-8e3e8e59762991e56dca-21bc-4197-b0bd-e6fc7e791391 Getting into that rhythm from the start can make staying on treatment much easier over time.
2. Review Your Vaccines Before Treatment Begins Vaccines are an important part of preparing for biologic therapy for a few reasons: IBD increases your risk of infections, but so do medications like biologics, because they can suppress the immune system, making it harder to fight off illnesses.e60dc2a1-f33c-4a05-9b50-8e3e8e59762913f7e9bf-e9bd-4174-bb7f-2d5efde23e4ae60dc2a1-f33c-4a05-9b50-8e3e8e597629e06d0c6c-b4b7-4659-9873-c77c621fb9b3 “Vaccines are important as they give our bodies protection against infections. Vaccines can greatly reduce the risk of having an infection, or if it occurs, reduce the severity of the infection,” Becker says. Your gastroenterologist will check your vaccination history for:e60dc2a1-f33c-4a05-9b50-8e3e8e59762980e1015f-3e20-4383-89ef-413a850aa0e1e60dc2a1-f33c-4a05-9b50-8e3e8e597629b01aff30-8740-4d2a-b17f-921dc6b0b276 Influenza (flu) vaccine COVID-19 vaccine and boosters (Moderna, Pfizer, Novavax) Pneumococcal (pneumonia) vaccine (Capvaxive, Pneumovax 23, Prevnar 20, Vaxneuvance) Shingles (recombinant herpes zoster) vaccine (Shingrix) Hepatitis A vaccine (Havrix, Vaqta) Hepatitis B vaccine (Engerix B, Heplisav-B, Recombivax HB) Hepatitis A and B combination vaccine (Twinrix) Tdap (tetanus, diphtheria, pertussis) vaccine (Adacel, Boostrix) HPV vaccine (Gardasil-9, Cervarix) Live attenuated vaccines — made from a weakened form of a virus or bacteria to trigger an immune response — aren’t normally given to people on biologic therapy. Your gastroenterologist will arrange for you to get these vaccines, if needed, about four weeks before starting a new therapy. These include:e60dc2a1-f33c-4a05-9b50-8e3e8e5976295cc1ddd1-849e-4298-bb48-b91a0ac8b6b3e60dc2a1-f33c-4a05-9b50-8e3e8e597629a8727ce1-3fea-4669-9a2b-a33e387c30a1 MMR (measles, mumps, and rubella) vaccine (M-M-R II, Priorix) Varicella (chickenpox) vaccine (Varivax) Oral typhoid vaccine (Vivotif) Yellow fever vaccine (YF-Vax)
4. Expect Regular Monitoring After You Start Biologic therapy requires ongoing monitoring, it’s not a “set-it-and-forget-it” approach, Moss says. He notes that monitoring is built into the process from the beginning, including: Regular blood tests (for blood counts, liver function, and inflammation markers) Stool tests, such as fecal calprotectin Periodic imaging via endoscopy (upper endoscopy, colonoscopy, or both) to confirm inflammation is under control Dr. Sheth says monitoring is a crucial step, especially since symptoms and inflammation don’t always line up. Expect monitoring closer together at first, during the induction phase. That could look like blood work and visits within the first three to six months, followed by a repeat endoscopy within the first year to confirm that the intestines are actually healing, he says.
5. Understand What Success Should Look Like — and When You Need to Pivot Expectations need to be set early. That’s because one of the most common pitfalls is assuming a biologic isn’t working quickly enough. “One mistake I can see is not giving a treatment enough time, thinking it isn’t going to work after just one or two doses,” Becker says. “Most of these medicines do take time to work.” How long that takes can vary depending on the drug. Some people may start to feel improvement within days, while others may need to wait 12 weeks or more. “It will take even longer to see the full effect of a medicine, at least four to six months in most cases. It is important to discuss what ‘success’ looks like with your medical team,” Becker says.e60dc2a1-f33c-4a05-9b50-8e3e8e5976295c8f382a-4657-4c36-9933-9375c9af1992 Sheth says success is measured in two ways: clinical remission and endoscopic remission. “You should be feeling better, but your inflammation should also be under control,” he says, noting that resolved inflammation is confirmed via blood work, stool tests, and an endoscopy. And if a biologic doesn’t help with easing symptoms or reducing inflammation within these timeframes, your gastroenterologist may check on drug levels and antibodies, adjust dosages or frequency, or switch to a different class of biologic or advanced therapy altogether, Moss says. “Having to pivot does not mean you have failed treatment,” he says.
3. Discuss Your Options With Your IBD Care Team Learning about your biologic therapy, including how it works, how it’s given, and its side effects is an important part of the process. Your options are determined by certain factors, including disease severity, location, or history, response to previous treatments, and how quickly a medicine can work, Becker says. There are even considerations outside of the gut, from co-occurring conditions and complications to insurance coverage. Expect to talk to your gastroenterologist about your biologic treatment plan. “In my conversations with patients, we review how each option works, its side effects, and how it is given and how often, so the choice truly feels shared rather than one-sided,” Moss says. These conversations have become much more detailed because there are more options than there used to be, says Anish Sheth, MD , a gastroenterologist and codirector of the Center for Digestive Health at Penn Medicine Princeton Health in Plainsboro, New Jersey. You can also ask whether it is considered safe during pregnancy or breastfeeding. “For some people, family planning, treatment frequency, and convenience may play just as big a role as mechanism of action,” he says.
The Takeaway Before starting a biologic for Crohn’s disease, completing recommended screenings and getting up to date on vaccinations helps to protect your immune system and lower the risk of serious infections once treatment begins. Choosing the right treatment for you means having an open conversation with your gastroenterologist about the different options that are available and how each one fits into your daily life — from dosing schedules and side effects to insurance coverage and comfort with self-injection or infusions. Regular follow-up and monitoring, including blood work, fecal calprotectin tests, and endoscopies, are key to making sure the treatment is working as intended and to quickly identify and manage any side effects or complications.
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