Comparing 6 Biologic Medications for IBD

Not All Biologics Work the Same Way When Treating IBD

Infusion Center
Many of the newer medications for treating Crohn's disease and other forms of inflammatory bowel disease are given by infusion, which means that they're administered by a nurse or a physician via an IV. Image © Caiaimage/Sam Edwards / OJO+ / Getty Images

The newest class of drugs that are used to fight the inflammation that is caused by inflammatory bowel disease (IBD) are called biologics. However, this is a very broad range of medications, and they don't all work the same way or are even given the same way. Some are approved to treat just one form of IBD, while others are used to treat both Crohn's disease and ulcerative colitis.

Because biologic drugs lower the effectiveness of the immune system (partly the reason why they work for IBD), people taking them could be prone to getting some types of infections.

It's important, therefore to take steps to make sure that protections are in place to prevent infections. People with IBD should receive vaccinations, ideally before starting a biologic, but many immunizations can also be given while taking a biologic.

How do physicians choose which biologic agent to recommend to a patient? There are a variety of differences between these drugs, and many factors are taken into consideration. Here is a look at many of the important facts about the biologics approved to treat IBD.

Cimzia

Cimzia (certolizumab pegol) is a tumor necrosis factor (TNF) blocker that was approved in 2008 to treat Crohn's disease. In 2009 it was approved to treat rheumatoid arthritis, and for psoriatic arthritis and ankylosing spondylitis in 2013. Cimzia is usually given by injection with a prefilled syringe at home. Cimzia is given with two injections, which are first administered in a loading dose at weeks 0, 2, and 4.

After that, the two injections are given every 4 weeks. Another form of Cimzia is a powder that is mixed and then injected at a doctor's office. Side effects that occur most commonly with this drug are upper respiratory tract infections (like a cold), viral infections (like the flu), rashes, and urinary tract infections.

Key points about Cimzia:

  • Cimzia is approved to treat Crohn's disease
  • Cimzia is usually given at home by injection
  • Cimzia is given initially 3 times in a series of 2 injections, 2 weeks apart, followed by 2 injections every 4 weeks
  • Common side effects include respiratory infections, viral infections, rashes, and urinary tract infections
  • Cimzia is a class B pregnancy drug
  • A low amount of Cimzia may pass into breastmilk
  • Cimzia needs to be refrigerated

Entyvio

Entyvio (vedolizumab), which was approved in May 2014, is a gut-homing α4β7 integrin antagonist. It is thought to work by binding to α4β7 integrin, which prevents the integrin from causing inflammation. Entyvio is approved for use in adults who have Crohn's disease or ulcerative colitis. Entyvio is always given by infusion, either in a doctor's office, at a hospital, or in an infusion center. The loading schedule for Entyvio is 3 infusions done 2 weeks apart. After that, infusions are given about every 8 weeks. Some of the potential side effects include a cold, upper respiratory tract infection (the flu, bronchitis), headache, joint pains, nausea, fever, fatigue, cough, back pain, rash, itching, sinus infection, throat pain, and extremity pain.

Key points about Entyvio:

  • Entyvio is approved for ulcerative colitis and Crohn's disease
  • Entyvio is given by infusion in 3 starting doses, and then every 8 weeks
  • Common side effects include infections (a cold, the flu, bronchitis, sinus infection); pain in the joints, back, throat or extremities; symptoms of nausea, fever, fatigue, cough, or itching; and a rash
  • Entyvio is a class B pregnancy drug
  • It's not currently known if Entyvio passes into breastmilk

Humira

Humira (adalimumab) is another monoclonal antibody and TNF inhibitor that is used to treat people with IBD. It is approved for adults and children over the age of 6 that have ulcerative colitis or Crohn's disease. Humira was initially approved in 2002, and expanded for use in Crohn's disease in 2007 and ulcerative colitis in 2012. Humira can be given at home through an injection. Patients are trained on how to give themselves the injection (or it could be done with help from a family member or friend).  Some people with Humira may have what's called an injection site reaction, which is swelling, pain, itching or redness at the place where the drug is injected. This can usually be treated at home with ice or antihistamine medications (changing injection sites every week also helps).

Key points about Humira:

  • Humira is approved for both Crohn's disease and ulcerative colitis
  • Humira is given at home by self-injection
  • Humira is started with 4 injections, followed by 2 injections 2 weeks later, and then 1 injection every other week
  • Common side effects include pain or irritation at the injection site and headache, rash, and nausea
  • Humira is a class B pregnancy drug
  • Infants born to mothers receiving Humira should not receive live vaccines for 6 months
  • Humira needs to be refrigerated

Remicade

The first biologic therapy approved for use in people with IBD is Remicade (infliximab), which was approved in 1998. Remicade is a monoclonal antibody which is a TNF inhibitor and is given to patients through an IV. This could be done in a doctor's office, but more often occurs in an infusion center, which are specialized facilities designed to administer medications by IV. Remicade could be used to treat Crohn's disease or ulcerative colitis, and it also approved for kids as young as 6, in certain circumstances. Remicade is thought to work in people with IBD because it inhibits TNF, which is a substance that creates inflammation in the body.

Key points about Remicade:

  • Remicade is given by IV
  • Remicade is approved for Crohn's disease and ulcerative colitis
  • Three starting doses are given (after the first dose, the second is 2 weeks later, third is 4 weeks after that)
  • After the starting doses, it's given about every 8 weeks (sometimes sooner if needed)
  • Common side effects are abdominal pain, nausea, fatigue, and vomiting
  • Remicade is a class B pregnancy drug
  • Remicade does not appear to pass into breast milk

Simponi

Simponi (golimumab) is a TNF inhibitor that's approved for treating ulcerative colitis. Simponi was approved first in 2009 to treat rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis. In 2013 it was approved to treat ulcerative colitis. Ankylosing spondylitis is a condition that can be associated with ulcerative colitis, which means that this medication could be used to treat both (or either) disorder(s). Simponi is given at home, so patients are trained by a healthcare provider on how to inject themselves (either by themselves or with help). Some of the adverse reactions to Simponi are getting infections that cause illnesses like a cold, symptoms like a sore throat or laryngitis, and viral infections like the flu. Having redness, pain, and itchiness at the injection site, often treated with ice and antihistamines, is another potential adverse reaction.

Key points about Simponi:

  • Simponi is approved to treat ulcerative colitis
  • Simponi is given by injection at home
  • Simponi is started with 2 injections, followed by 1 injection 2 weeks later, and 1 injection every 4 weeks thereafter
  • Common side effects include pain or irritation at the injection site and upper respiratory or viral infections
  • Simponi is a Type B pregnancy drug
  • It's not currently known how Simponi will affect a nursing infant
  • Simponi must be refrigerated

Stelara

Stelara (ustekinumab) is a fully human monoclonal immunoglobulin antibody. It was first approved in 2008 as a treatment for plaque psoriasis and in 2016 to treat Crohn's disease. Stelara works to decrease the inflammation Crohn's disease causes by targeting interleukin (IL)-12 and IL-23, which are thought to play a role in the development of inflammation in the intestine. The first dose of Stelara is given by infusion, in an infusion center or a doctor's office. After that first infusion, Stelara can be taken at home with an injection that's given every 8 weeks. Patients can give themselves the injection after being trained by a healthcare provider.  Some of the more common side effects seen in people with Crohn's disease who take Stelara include vomiting (during the first infusion), pain or redness at the injection site, itching, and infections such as a cold, a yeast infection, bronchitis, urinary tract infection, or sinus infection.

Key points about Stelara:

  • Stelara is approved to treat Crohn's disease
  • The loading dose of Stelara is given by infusion and thereafter is given by injections at home
  • People taking shots for allergies should talk to their doctor about possible allergic reactions and Stelara
  • Common side effects include infections, injection site reactions, and vomiting
  • Stelara is a class B pregnancy drug
  • It's thought that Stelara does pass into breastmilk
  • Stelara must be refrigerated

Sources:

Janssen Biotech, Inc. "Simponi Medication Guide." May 2013.

Janssen, Inc. "Stelara (ustekinumab) Prescribing Information." Stelarainfo.com. Aug 2016.

Mother To Baby. "Certolizumab Pegol (Cimzia) and Pregnancy." MotherToBaby.org. Aug 2015.

Takeda Pharmaceuticals, Inc. "About Entyvio." Entyvio.com. 2015.

UCB, Inc. "Cimzia (Certolizumab Pegol) Medication Guide." Cimzia.com. Apr 2016.

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