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Infusions for Ulcerative Colitis and Crohn's Disease


Biologic Therapies

Medical treatment for Crohn’s disease and ulcerative colitis has two main goals: achieving remission (control or resolution of inflammation leading to symptom resolution) and then maintaining remission.

Over the last several years, new treatments called biologics have been available for the treatment of inflammatory bowel disease (IBD) and other inflammatory diseases. These treatments are called biologics because, unlike chemical medications, they are made out of materials found in life.

Biologics are antibodies grown in the laboratory that stop certain proteins in the body from causing inflammation. Biologic therapies offer a distinct advantage in IBD treatment because their mechanisms of action are more precisely targeted to the factors responsible for IBD. For example, unlike corticosteroids, which affect the whole body and may produce major side effects, biologic agents act more selectively. These therapies are targeted to particular proteins that have already been proven to be involved in people with IBD. 
 

Anti-Tumor Necrosis Factor Agents

Biologics known as anti-tumor necrosis factor (anti-TNF) agents bind and block a small protein called tumor necrosis factor alpha (TNF-alpha) that promotes inflammation in the intestine as well as other organs and tissues. All anti-TNF medications have been shown to not only reduce the symptoms of IBD, but also result in healing of inflamed intestine. While anti-TNF medications are not effective for every individual, many patients benefit from this class of medication. It may take up to 8 weeks after starting an anti-TNF to notice an improvement in symptoms, though many experience more immediate improvement.

At Buffalo Niagara Gastroenterology we use Infliximab (Remicade®) for Infusions. Infliximab (Remicade®) has been approved for the treatment and maintenance of remission of moderate to severe Crohn’s disease and ulcerative colitis (in adults and children). It is also approved for reducing the number of draining enterocutaneous and rectovaginal fistulas and maintaining fistula closure in adult patients with fistulizing disease. It is given by an intravenous infusion lasting approximately two to four hours. The first three doses are given more closely together, at zero, two, and six weeks, and thereafter usually every six to eight weeks.


Risks and Special Considerations

While the benefits often far outweigh the risks of biologic medications in patients suffering from IBD, patients should consider the following when using biologics:
Side Effects & Intolerance.  Because biologics are given by intravenous infusions or subcutaneous injections, they may produce redness, itching, bruising, pain, or swelling at the injection site. Other side effects may include: headache, fever, chills, hives and other rashes.  Occasional severe allergic reactions may occur.

  • Infections.  Because biologics affect the immune system to help control IBD, biologics can impact your ability to fight infections.  Further, anti-TNF medications increase the risk of developing less common, or atypical, infections.  While the majority of patients using biologics never experience an infection related to the medication, it is important to discuss this issue with your IBD specialist.  Because of this risk, it is important to determine if a patient has any chronic asymptomatic infections that may become reactivated when using these medications, including tuberculosis (TB) and chronic Hepatitis B virus.  Further, to help prevent infections, patients should be up-to-date on appropriate vaccinations, including yearly influenza vaccinations.  If you develop any signs of infection while taking these medications, such as fever, new cough, or the flu, inform your doctor immediately.
     
  • Cancer Risk.  Anti-TNF medications have been associated with a small, but measurable, increase in the incidence of lymphoma, an uncommon cancer.  While the overall risk of lymphoma is very low, the risk is highest in patients using anti-TNF medications in combination with another immunosuppressant, such as azathioprine (Imuran®).
     
  • Liver Problems.  Biologic therapies have been rarely associated with changes in liver function.  If you develop jaundice (yellowing of skin and eyes) while using biologics, inform your doctor immediately.
     
  • Arthritis.  While anti-TNF medications often are effective treatments for inflammatory arthritis (joint pain), in some situations they may cause new joint pain.  Notify your doctor if you are experiencing new joint discomfort while using anti-TNF medications.
     
  • Lupus-like Reaction.  Rarely an anti-TNF medication can cause a lupus-like reaction (LLR) which may present with symptoms such as a rash, joint pain, muscle ache, and/or fever. The LLR usually resolves with stopping the anti-TNF, but may require a course of corticosteroids.
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  • Other Considerations.  Tell your doctor if you have any other health problems such as heart failure, hepatitis or multiple sclerosis before taking these treatments.   Your doctor will determine if the benefits of biologics outweigh the risks in your individual situation.
On rare occasions, nervous system disorders also have been reported. Let your doctor know if you have or have had a disease that affects the nervous system, or if you experience any numbness, weakness, tingling, or visual disturbances while using anti-TNF medications.
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