6 Myths and Facts About Biologics for Crohn’s Disease

It’s normal to have questions or concerns about a new treatment when you’re trying to manage your Crohn’s disease. Especially if your doctor is recommending an advanced therapy, like a biologic.

“Over the last 25 years, they have completely changed the treatment landscape for Crohn’s,” says Edward Oldfield IV, MD, a gastroenterologist at Sentara Gastroenterology Specialists in Norfolk, Virginia.

Having the facts about these drugs can help you feel more empowered about your treatment. Here are some of the most common myths about biologics for Crohn’s disease and the truth about each one.

1. Myth: Biologics Are a Last-Ditch Option

“They’re no longer considered a treatment of last resort,” says Pikeshkumar Patel, MD, a gastroenterologist with Trinity Health of New England Medical Group in Waterbury, Connecticut.

• adalimumab (Humira)
• certolizumab pegol (Cimzia)
• inflixumab (Remicade)
• guselkumab (Tremfya)
• mirikizumab (Omvoh)
• risankizumab (Skyrizi)
• ustekinumab (Stelara)
• vedolizumab (Entyvio)

If your gastroenterologist is recommending a biologic before you’ve met your insurer’s step-therapy requirements, you can work with your doctor to get a prior authorization to increase the chance that your biologic prescription will be covered.

2. Fact: Biologics Treat Inflammation, Not Just Symptoms

3. Myth: Biologics Are More Dangerous Than Steroids

Both steroids and biologics have risks. But they’re very different medications that are used in different ways to treat Crohn’s.

“They’re undoubtedly the riskiest of our treatment options for Crohn’s,” says Oldfield.

“For many patients with moderate to severe Crohn's disease, the risks of uncontrolled disease and long-term steroid use are greater than the risks associated with biologic therapy,” says Dr. Patel.

4. Fact: Biosimilars Can Be Just as Effective, but Are Less Expensive

Much like generic versions of other brand-name drugs, a biosimilar can be an alternative to a brand-name biologic drug that costs less and has fewer insurance coverage barriers. “I usually choose the biosimilar if an insurer denies or refuses to cover a specific reference biologic. Prescribing an approved biosimilar is a standard and highly effective strategy to secure access to care,” says Patel.

5. Myth: Biologics Shut Down Your Immune System

Because biologics change how part of your immune system works, the medications can increase the risk for certain infections. But “for many patients, the benefits of controlling the disease [with a biologic] significantly outweigh the potential risks of therapy,” says Patel. “Uncontrolled Crohn's disease … can lead to hospitalizations, surgeries, nutritional problems, and other serious complications.”

• Flu
• COVID-19
• Pneumonia
• Herpes zoster
• Human papillomavirus (HPV)
• Respiratory syncytial virus (RSV)
• Tetanus, diphtheria, pertussis (Tdap)
• Hepatitis A and B
• Measles, mumps, and rubella (MMR)
• Varicella

You can also come up with a plan to address signs of a possible infection (like fever or coughing) quickly, before the infection becomes serious.

6. Fact: Finding the Right Biologic — and Seeing an Improvement — Can Take Time

“This usually means checking a stool test about three months after starting therapy and usually repeating an imaging study or colonoscopy about 6 to 12 months after starting treatment, depending on the particular medication,” says Oldfield.

If a biologic isn’t helping you or it starts to become less effective over time, you and your doctor can talk about trying another option. “It is relatively common for patients to try more than one biologic before finding the therapy that works best for them,” says Patel. In time, you’re likely to find a therapy that helps you feel better.