Biologics and other Targeted Medicines for Inflammatory Bowel Disease

Telephone: 0191 4453148

This leaflet contains information about biologics and other targeted medicines used to treat inflammatory bowel disease (IBD).

Why have I been given this leaflet?

The leaflet will help you to remember what your doctor has told you about this medicine. It will also help you to decide whether you want to go ahead with the treatment.

This leaflet aims to provide information regarding biologics and other targeted medicines for your inflammatory bowel disease (IBD): ulcerative colitis (UC) or Crohn’s disease.

What are biologics and other targeted medicines?

Crohn’s Disease and Ulcerative Colitis cause inflammation in your gut, and sometimes other parts of your body. Biologics and other targeted medicines are treatments that block particular proteins or chemical pathways involved in inflammation. This reduces inflammation.

• Biologic medicines are antibodies that are made by living cells in a lab. Antibodies are proteins that recognise and stick to specific targets. They are large, complex molecules. Biologics have been used to treat Crohn’s or Colitis for over 20 years.
• Other targeted medicines are made by chemical processes. They are smaller and less complex than biologics. They are sometimes called ‘small molecule’ medicines. The first targeted small molecule medicine became available for Colitis in the UK in 2018.

Who might have this medicine?

Biologics and other targeted medicines may be an option for people with moderate to severe Crohn’s Disease or Ulcerative Colitis: They are often considered:

• When other medicines such as immunosuppressants (Azathioprine, Mercaptopurine, and Methotrexate) or steroids or mesalazine have not worked well or have stopped working
• When other medicines have had bad side effects
• In combination with other medicines
• They might also be used as a first medicine if the IBD team feel they are the best option for you. They may be especially useful in people with severe Crohn’s or Colitis or people who also have non-gut symptoms or fistulas

Which biologics or targeted medicines are used to treat ulcerative colitis and Crohn’s disease?

There are many different biologics or targeted medicines use to treat inflammatory bowel disease. Some are used in either ulcerative colitis (UC) or Crohn’s disease, but some can treat both. Sometimes they can only be used in certain circumstances, like when other options have not worked.

The tables below show which medicines are used in this hospital and how you take them. More are being developed all the time so this may not be an up-to-date list. The IBD team will give you further information on each medicine if needed and you can also find more information on the Crohn’s and Colitis UK website.

Biologics used for IBD at the Queen Elizabeth hospital

Other targeted medicines (small molecules) used for IBD at the Queen Elizabeth Hospital

Starting biologics and other targeted medicines

Deciding to take a new medicine can feel like a big step. There are lots of things to think about. The IBD team will discuss your options with you. Some people worry about having injections or blood tests, taking time off work for treatment, or having a lowered immune system. But biologics and other targeted medicines can help get Crohn’s or Colitis under control and keep them under control.

There are many different treatments available, and it can be difficult to predict which one will work best for you. The IBD team might give you a choice of different treatments. You should consider the potential benefits, possible risks, and the goals of your treatment together.

How to take biologics and other targeted medicines

How you take this medication depends on the type of medication you are started on.

Biologics can’t be given by mouth as they are broken down in the gut which will stop them working. Instead, you either have them as an infusion (a drip in your arm) in the hospital day case ward, or as an injection under your skin at home. The injection under the skin (called a subcutaneous injection) in given using either a pre-filled pen, a pre-filled syringe, or an on-body injector device. You can inject this yourself or ask a relative to do it for you. We will show you how to use the devices in clinic. They will be delivered to your home using a Homecare service. You don’t have to pay for this medication.

Depending on which medicine you are on, you might:

• Have all your doses as infusions
• Have all your doses as injections
• Start off having infusions and then swap to injection

Other targeted medicines can be given by mouth as tablets. Depending which medicine, you have you will take it once or twice a day.

Do I need any checks before I start treatment?

Before you start a biologic or other targeted medicine, we will ask you some questions and do some blood tests. We may also do a chest X-ray. The blood tests include tests to check if you have been exposed to a variety of infections (e.g., tuberculosis, hepatitis, HIV). We will also make sure your vaccinations are up to date.

We will also ask you about other medical conditions you have so make sure the biologic or targeted treatment is appropriate for you.

All of these checks are to make sure the treatment is suitable and safe for you to have.

Do I need any special checks while on biologics or other targeted medicines?

Blood tests are required regularly whilst taking this medication. Initially, this is every month for the first 3 months then every three months after that. We check your full blood count which includes white cells (help to fight infection), red cells (carry oxygen in your blood) and platelets (help blood to clot). We also check your kidney and liver function. Sometimes we may need check other tests such as cholesterol.

It is very important that you keep up to date with the blood tests so we can continue your medication safely.

Pregnancy and Breastfeeding

Talk to the IBD team if you are pregnant, plan to get pregnant or think you are pregnant. Some biologics may be continued in pregnancy, but this can be discussed with the IBD team before any treatment is started.

Are there any Side Effects?

Most medicines cause side effects. Everyone reacts differently to medicines. You may have some side effects or none at all.

As biologics and other targeted medicines affect the immune system you may be more prone to infections. Other side effects vary depending on the medicine. You will be given more information about individual medicines by the IBD team at your clinic appointments.

Can I change to another treatment?

If the first biologic or targeted treatment you try is not right for you, you may need to change to a different one. The decision about which treatment to try next depends on several factors. The IBD team will discuss this with you and make the decision together. There are many reasons why you might need to change for example, the treatment does not work well, or the treatment stops working or you have side effects that are hard to manage.

Sometimes we may suggest you switch to a different brand for example if a different brand is cheaper or if a different brand has an injection device that might suit you better.

For biologic medicines, different brands are slightly different from each other. This is because biologics are very complex medicines made by living cells, so it is not possible to make an exact copy. These slightly different brands are called biosimilars. They are very similar to the original medicine. Biosimilars are thoroughly tested to make sure they are just as safe and effective as the original brand.

How long will I stay on this treatment?

The IBD team will review your treatment regularly. If it is working and you are not getting serious side effects, then we are likely to continue the treatment. If your Crohn’s or Colitis stays under control for a long time, we might discuss the option of stopping your biologic or other targeted medicine. If you do stop treatment, we will monitor you if your symptoms come back, you have the option to start treatment again.