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Living Well with Inflammatory Bowel Disease

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How Biologics Work to Relieve Ulcerative Colitis Inflammation

Medically Reviewed By Philip Ngo, PharmD

Drugs called biologics can be a treatment option for people with ulcerative colitis (UC). Biologics can help improve symptoms, achieve remission, and improve quality of life. 

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Ulcerative colitis (UC) is a form of inflammatory bowel disease (IBD) where the immune system attacks the tissues of the digestive tract causing inflammation. In UC, the inflammation occurs in the colon and can cause the following symptoms:

  • abdominal pain
  • bloody diarrhea that may contain mucus
  • fever
  • malaise, which is a general feeling of not being well
  • urgent or frequent need to have a bowel movement, but not always being able to have one
  • weight loss

These symptoms may begin gradually. Most people have relapsing symptoms with periods that are symptom free. Depending on how severe the disease is, some people have symptoms outside the digestive tract. This can include eye problems, joint pain, and skin flare ups.

Doctors often start treating UC with the following types of medications:

  • Aminosalicylates: Anti-inflammatory medicines, such as mesalamine (Pentasa, Rowasa, and others) and sulfasalazine (Azulfidine)
  • Corticosteroids: Anti-inflammatory drugs, such as budesonide (Entocort EC, Uceris) and prednisone
  • Immunosuppressants: Drugs that restrain immune system activity, such as azathioprine (Azasan, Imuran)and mercaptopurine (Purinethol, Purixan)
  • Janus kinase (JAK) inhibitors: small molecule therapy, such as tofacitinib (Xeljanz) and upadacitinib (Rinvoq).

If these treatments do not help to achieve remission or maintain it, biologics may be an option.

How biologics work in ulcerative colitis

Traditional medicines that treat UC work in one of two ways. Anti-inflammatory drugs try to interrupt the process of inflammation. They work on steps in the inflammatory process, but do not stop the cause of it.

Immunosuppressants reduce the activity of the immune system helping reduce inflammation. Specifically, they reduce the activity of white blood cells, which are the warriors of the immune system. However, they do this by reducing the activity of white blood cells throughout the body. It is a blanket approach to suppressing the immune system in UC. 

Biologics are different, they are a form of targeted therapy. They target very specific proteins and receptors (sites on cells) of the immune system that are involved in the inflammation of UC. In this way, they work on the very root of the inflammation.

Biologics are able to work on specific UC targets because scientists design them in a lab. They are manmade antibodies called monoclonal antibodies (mAbs) Trusted Source PubMed Central Highly respected database from the National Institutes of Health Go to source .

An antibody is a protein that the immune system makes. Normally, antibodies target invaders, such as bacteria or viruses, and attach to them. This helps the immune system get rid of the invader. Each antibody has a very specific design so it can target a specific invader. Your immune system makes countless different antibodies.

Scientists make mAbs that can latch on to the specific proteins or receptors they want to target in UC. The mAb then blocks the activity of the protein or receptor to reduce inflammation.

Current biologics for ulcerative colitis

Current UC treatment guidelines recommend biologics as standard care for people with moderate to severe disease. The biologics with approval to treat UC include:

  • adalimumab (Humira)
  • golimumab (Simponi)
  • infliximab (Remicade)
  • ustekinumab (Stelara)
  • vedolizumab (Entyvio)
  • mirikizumab-mrkz (Omvoh)

Research Trusted Source PubMed Central Highly respected database from the National Institutes of Health Go to source  suggests these drugs are very effective at helping people with UC achieve and maintain remission. However, the response to biologics can vary from person to person. Not everyone will respond to a specific biologic drug in the same way. A biologic that brings remission to one person may not help or may only help for a short time in someone else.

Biologics may also help reduce the need for surgery or hospitalization in some people with moderate to severe UC. This is a major benefit because up to 15% of people with moderate to severe UC eventually need surgery.

In hospitalized patients, the rate is as high as 30% for people with acute severe ulcerative colitis. But, again, the success of biologics can vary, and some people may still eventually need surgery.

Takeaway

If you still have symptoms with your current UC treatment, talk with your doctor about biologics. As with any drug, there are risks to taking a biologic, and side effects are possible. It is important to understand these issues if you decide to try a biologic drug. Together, you and your doctor can find the right treatment option for you.

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  1. Awan H, et al. (2023). The efficacy of currently licensed biologics for treatment of ulcerative colitis: A literature review. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10105519/
  2. Biologics factsheet. (2018). https://www.crohnscolitisfoundation.org/sites/default/files/legacy/assets/pdfs/biologic-therapy.pdf
  3. Feuerstein JD, et al. (2020). AGA clinical practice guideline on the management of moderate to severe ulcerative colitis. https://www.gastrojournal.org/article/S0016-5085(20)30018-4/fulltext
  4. Lynch WD, et al. (2023). Ulcerative colitis. https://www.ncbi.nlm.nih.gov/books/NBK459282/
  5. Malik B, et al. (2023). Understanding how monoclonal antibodies work. https://www.ncbi.nlm.nih.gov/books/NBK572118/
  6. Ulcerative colitis. (2020). https://www.niddk.nih.gov/health-information/digestive-diseases/ulcerative-colitis

Medical Reviewer: Philip Ngo, PharmD
Last Review Date: 2023 Nov 17
View All Living Well with Inflammatory Bowel Disease Articles
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