Uncovering Biologics: Your IBD BodyGuard!



Questions to Ask Your Doctor About Biologics for Crohn's Disease

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If you have moderate to severe active Crohn’s disease that’s not responding to standard treatments, your doctor may recommend that you try a biologic drug next.

Biologic therapies have been hailed as a major advance in the treatment of Crohn’s disease. They offer a more targeted approach and can be very safe and effective. In fact, they may have fewer side effects than some other medications for Crohn’s disease. For instance, unlike corticosteroids that work by suppressing the entire immune system, biologics target specific proteins in the immune system that are associated with inflammation. Taking biologics is more complicated than swallowing a pill though, and they pose different health risks than other Crohn's disease medications.

To make the most informed decision, talk to your doctor about biologics. Each person with Crohn's disease is different, so the conversation will be specific to your condition and concerns. The answers may even be different for you than other people that have the disease. Use these questions to start a dialogue with your doctor:

1. Why do you think biologics will work for my Crohn’s disease?

Why this is an important question about biologics: To achieve remission, the right Crohn's disease treatment choice depends on the severity of your disease. Understanding why biologics are the next step in your treatment plan can give you a better perspective on your condition. For instance, your doctor might recommend biologic drugs to treat your Crohn’s disease because you aren’t responding well enough to other drugs. Or, it could be that the targeted nature of a biologic medication will bring you relief with fewer side effects.

Although biologics are generally recommended for people with moderate to severe Crohn’s disease, it’s important not to wait until it’s too late to use biologics. That’s because these medications can lose some of their effectiveness in people with advanced cases of the disease, says Terilyn Scott-Winful, MD, a gastroenterologist with Baylor Scott &WhiteHealthinPlano,Texas.

"Youdon’thavetowaitforthediseasetobesoseveretousebiologics,”shesays.“Youhavetostayonestepaheadofdisease.”

Askwhyyourdoctorthinksbiologicsmaybethebestoptionforyouanddiscussyourexpectationsaboutyourshort-andlong-termCrohn’sdiseasetreatmentplan.

2.WhataretherisksoftryingbiologicsforCrohn’sdisease?

Whythisisanimportantquestionaboutbiologics: Youwanttoweightheadvantagesanddisadvantagesoftakingabiologicdrugbeforestartingtreatment.Althoughseriousrisksaregenerallyrare,potentiallydangerousinfections,suchastuberculosis,havebeenassociatedwiththemedications,accordingtotheCrohn's&ColitisFoundationofAmerica(CCFA).Rarecasesofblooddisordersandcancerofthelymphnodes(lymphoma),aswellasliverproblems,havealsobeenreported.

Dr.Scott-Winfulsaysthatbiologicshavebeensafelyusedbymillionsofpeopleformorethan15yearsnowandthattherisksmaybeexaggerated,addingthatsometimespeoplefocusontheveryrarebutseriouseventsratherthantheday-to-daybenefits,suchasfewerCrohn’sdisease flares.It’simportanttohavethisdiscussionwithyourdoctortoweightherisksandbenefitsconsideringyourfullhealthprofile.

3.Howwillabiologicdrugbeadministered?

Whythisisanimportantquestionaboutbiologics: Biologicdrugsareavailableonlybyintravenous(IV)infusionsatamedicalfacilityorbyinjectionthatyouorsomeoneelsecangiveathome.Ifyou'reuncomfortablewiththisprocess,anIVinfusionmightbeabetterchoice.Ontheotherhand,infusionstendtotakeacoupleofhourseachtime,whichmightbemoretaxingonyourschedule.KeepinmindthatconsiderationforthemethodofdeliveryofthedrugissecondarytowhichbiologicmedicationismorelikelytohelpyourCrohn'sdisease.

4.HowoftenwillIgetthebiologicdrug?

Whythisisanimportantquestionaboutbiologics: Eachbiologicmedicationhasadifferenttreatmentschedule,whichrangesfromeverytwoweekstoonceamonth,soyou'llwanttofindoutthespecificsfirst.Alsoaskaboutanyfrequencydifferencesbetweeninitialandongoingtreatmentschedulestotreatflaresandtoinduceandmaintainremission.

5.HowlongcanIexpectthebiologicdrugtobeeffective?

Whythisisanimportantquestionaboutbiologics: “There’sasmallamountoflossofresponsetothedrugovertime,”Scott-Winfulsays.Makesureyouunderstandwhatwillhappenifthebiologicmedicationyou’retakingloseseffectivenessandhowyourdoctormayalteryourtreatmentregimenorwillrecommendswitchingdrugs.Askyourdoctorwhatkindofeffectyoucanexpectfromthedrugintheshort-andlong-termandwhatalternativeoptionsareavailable.

6.Howexpensivearebiologicdrugs?

Whythisisanimportantquestionaboutbiologics: Dependingonthedrugandhowfrequentlyyouneedtreatment,thecostofbiologicscanrangefromabout,100tomorethan,000,averagingabout,000perinfusionorinjection,accordingtoresearchpublishedinBMJOpenGastroenterologyin2019.Acheaperoptionmaybebiosimilars,whichwereapprovedbytheFoodandDrugAdministrationforCrohn'streatment.(Thinkofthemasgenericversionsofbiologics,whichcanbelessexpensive.)Infliximab-dyybisaninfliximabbiosimilar,andadalimumab-attoisabiosimilartoadalimumab.Talktoyourdoctoraboutthedifferencesbetweenthesedrugclasses.Ifyourinsurancedoesn'tcovertreatmentwithbiologics,askyourdoctorwhetherthereareotherpaymentoptionsavailable; for example, you may be a candidate for an assistance program offered by drug companies and other organizations.

7. What side effects might I experience from taking a biologic drug?

Why this is an important question about biologics: Although biologics have fewer side effects than other Crohn’s disease drugs, you still need to know what side effects to expect and how you can manage them. For example, pain, itching, bruising, and redness at the injection site are common, according to the CCFA. Headache, nausea, fever, chills, and hives are other possible complications. Ask your doctor if there are specific side effects associated with the particular biologic medication your doctor is recommending for you and when to call his or her office if side effects occur.

8. Are there other biologic drug options in the pipeline that might work for me?

Why this is an important question about biologics: In 2019, in addition to approving biosimilars for Crohn's, the FDA approved ustekinumab, a biologic that targets IL-12 and IL-23, proteins involved in inflammation, and has been used for psoriasis. There are also several new biologic therapies under investigation for the treatment of Crohn’s disease, as well as new types of oral drugs that target key parts of the intestines. If one of these drugs holds more promise for you, you may be eligible to participate in a clinical trial. If your Crohn’s disease is currently well-controlled, your doctor may recommend waiting until newer drug options become available to start biologic treatment.

Additional reporting by Diana K.






Video: You Should Ask Your Doctor These Questions if You Have Crohn's Disease or Ulcerative Colitis

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Date: 11.12.2018, 08:36 / Views: 44242