Biologics are medications made from antibodies that prevent certain proteins in the body from causing inflammation. Different types target different proteins. They’re usually injected or infused.

A doctor may recommend biologics to treat ulcerative colitis (UC) if conventional medications do not help you achieve and maintain remission.

Conventional UC medications include:

  • aminosalicylates
  • steroids
  • immunosuppressive drugs

Read on to learn what biologics are, the different types and what they do, and how they can help manage UC.

Biologics are different from conventional UC medications. They are made from laboratory-grown antibodies. Their natural properties can prevent certain problem proteins in the body from causing inflammation.

When they’re injected into the body, they fight off inflammation that causes discomfort for people living with UC.

Biologics target specific areas in the body, making them more effective for some people. In contrast, steroids or other drugs affect the entire body and may have unwanted side effects.

Three types of biologics used to manage UC include:

  • anti-tumor necrosis factor (anti-TNF) agents
  • integrin receptor antagonists (IRAs)
  • interleukin (IL) inhibitors

Anti-TNF agents bind to and block the protein called tumor necrosis factor-alpha (TNF-alpha). In people with UC, this protein causes inflammation in the:

  • intestines
  • organs
  • tissues

Blocking this protein is important for UC remission. Anti-TNF agents are not only able to help you maintain remission, but some can also actually heal inflamed intestinal areas.

Anti-TNF agents for UC include:

  • Infliximab (Remicade): This drug is used to treat moderate to severe UC that has not improved with other drugs or in people who cannot take other drugs. It comes as an infusion you receive through a vein. The process takes 2 hours. You’ll receive three doses over the first 6 weeks and then one dose every 8 weeks.
  • Infliximab-dyyb (Zymfentra): This prescription medication is injected under the skin for maintenance treatment of moderate to severe UC after intravenous (IV) administration of infliximab. You can start receiving the injections 10 weeks after the IV treatment. You usually administer the injection once every 2 weeks.
  • Golimumab (Simponi): This injectable medication is typically recommended for treating UC in people who are having trouble stopping the use of steroids. It can be administered at home or by a doctor. You usually receive two subcutaneous injections on your first day and one injection 2 weeks later. After the third injection, you’ll receive doses every 4 weeks.
  • Adalimumab (Humira): This prescription medication is subcutaneously injected into the abdomen or the thigh for moderate to severe UC treatment. After your doctor shows you how to use this drug, you can administer it at home every 2 weeks. Your doctor may check in with you at 8 weeks. If you have not achieved remission, your doctor may have you stop this drug.

These medications block the protein on the surface of key inflammatory cells, stopping them from moving freely from the blood into body tissues.

Vedolizumab (Entyvio) is an IRA. This intravenous (IV) medication treats UC that has not responded to other UC treatments and in people who are trying to avoid taking steroids.

The infusion process takes about 30 minutes. You get three doses in the first 6 weeks of treatment, followed by one dose every 8 weeks. Alternatively, you may be able to switch to subcutaneous injections after completing at least two IV infusions.

This type of biologic targets proteins involved in the process that leads to inflammation.

IL inhibitors for UC include:

  • Ustekinumab (Stelara): This drug targets the proteins interleukin-12 and interleukin-23. It’s recommended for treating moderate to severe UC that has not improved with other treatments. The first dose is administered as an IV infusion at your doctor’s office or clinic, a process that takes at least an hour. You’ll then get an injection every 8 weeks afterward. You can perform the maintenance subcutaneous injections yourself, or your doctor can do them.
  • Mirikizumab-mrkz (Omvoh): This drug targets the protein interleukin-23. It’s recommended for treating moderately to severely active UC. You receive the first doses as an IV infusion and later doses as an injection under the skin every 4 weeks. Injections can start 12 weeks after the first infusion. A doctor can teach you to perform the injections yourself.

Biologics, like other medications, have pros and cons.

Pros

One of the biggest advantages of using biologics is that they target certain areas of inflammation in the body rather than affecting the entire immune system the way steroids or immunosuppressants might. For some people, this targeted attack may mean less severe side effects and fewer side effects in general.

Another benefit is that many biologics are administered every 2 weeks up to every 8 weeks, which may be more convenient than daily dosing.

Research from 2019 suggests that biologics may also reduce the need for surgery or hospitalization.

Cons

However, one drawback of biologics is that they can be quite expensive. Even biosimilars, which are medications that are incredibly similar to certain biologics that are supposed to be much cheaper (like generic medications), are still expensive. However, the introduction of biosimilars has helped reduce the costs of biologics over time.

Another potential issue of biologics is that many of them have to be administered via IV at a healthcare facility or as a subcutaneous injection. This can make taking them more complicated than taking a pill.

It’s also possible for biologics to stop being effective over time, in which case you will need to work with your doctor to find either another biologic or another form of medication to try.

Like most medications, biologics have possible side effects, including:

  • a reaction, such as discoloration or swelling, at the injection site
  • headaches
  • fever
  • chills
  • a severe allergic reaction (rare)

Some more serious risks include decreased immune system function that can leave you susceptible to infections. You may also be more likely to experience:

  • lymphoma
  • liver problems
  • a worsening of heart conditions
  • arthritis

Talk with your doctor if you experience any side effects.

If you’re interested in trying a biologic, it’s best to discuss all the pros and cons with your doctor.

If you’ve already tried other drugs to treat your UC without any benefit, you might be a great candidate for a biologic.