Biologics for Inflammatory Bowel Disease

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Biologics for Inflammatory Bowel Disease


Generic NameBrand Name

How It Works

These medicines stop a protein that increases inflammation in the body. They block the inflammatory response that happens in Crohn's disease and ulcerative colitis. They are given as a shot. Infliximab and natalizumab are given as a shot in a vein (intravenous, or IV). Adalimumab and certolizumab are given as a shot under the skin (subcutaneous).

Why It Is Used

Infliximab was first used to treat abnormal connections (fistulas) between the intestines and organs in moderate to severe Crohn's disease. Now it is used to induce and maintain remission (a period without symptoms) in people who have Crohn's disease or ulcerative colitis that has not improved with other medicines.

Adalimumab, certolizumab, and natalizumab are used to induce and maintain remission in people with Crohn's disease who have not improved with other medicines and who no longer respond to or cannot tolerate treatment with infliximab.

How Well It Works

Crohn's disease

In multiple studies, almost 70% of people taking infliximab had fewer symptoms or had healed fistulas.1

Adalimumab has shown promise in treating Crohn's disease in multiple studies.2 It works like infliximab and may be good for people who are allergic to infliximab.

Certolizumab works in some people to stop the symptoms of Crohn's disease. In these people, certolizumab works well to help keep them free of symptoms (in remission).3, 4

Studies show that natalizumab works to stop the symptoms Crohn's disease in some people and to keep some people free of symptoms. But natalizumab may cause a serious and life-threatening disease called PML. Because of this risk, natalizumab is only available through a special prescription drug program.5

Ulcerative colitis

In one study, between 60% and 70% of people with ulcerative colitis were better 8 weeks after getting infliximab treatment. In another study, twice as many people got better after receiving infliximab compared to those taking a placebo.6

Side Effects

All medicines have side effects. But many people don't feel the side effects, or they are able to deal with them. Ask your pharmacist about the side effects of each medicine you take. Side effects are also listed in the information that comes with your medicine.

Here are some important things to think about:

  • Usually the benefits of the medicine are more important than any minor side effects.
  • Side effects may go away after you take the medicine for a while.
  • If side effects still bother you and you wonder if you should keep taking the medicine, call your doctor. He or she may be able to lower your dose or change your medicine. Do not suddenly quit taking your medicine unless your doctor tells you to.

Call 911 or other emergency services right away if you have:

  • Trouble breathing.
  • Hives.
  • Swelling of your face, lips, tongue, or throat.

Call your doctor right away if you have:

  • Signs of illness or infection, such as chills, cough, or fever.
  • Chest pain or tightness.
  • A rash on your head, face, or belly.
  • Belly pain or fullness.
  • Lower back or side pain, especially with painful urination.

Common side effects of this medicine include:

  • Stomach pain, nausea, and vomiting.
  • Painful throat.
  • Redness, itching, or swelling at the injection site.
  • Skin problems, such as bleeding, blistering, or crusting.

What To Think About

Warnings about serious side effects of biologics have been issued. Health Canada, the U.S. Food and Drug Administration (FDA), and the drug’s manufacturers have warned about:

  • An increased risk of a serious infection. Biologics affect the body's ability to fight all infections. So if you get a fever, cold, or the flu while you are taking this medicine, let your doctor know right away.
  • An increased risk of blood or nervous system disorders. Call your doctor if you have symptoms of blood disorders (such as bruising or bleeding) or symptoms of nervous system problems (such as numbness, weakness, tingling, or vision problems).
  • An increased risk of lymphoma (a type of blood cancer) in children and adolescents who take this medicine for longer than 2½ years (30 months). Adults, children, and adolescents who take this medicine also have a higher risk for leukemia and other cancers.
  • An increased risk of liver injuries. Call your doctor if your skin starts to look yellow, if you are very tired, or if you have a fever or dark brown urine.
  • An increased risk of psoriasis.

In very few cases, natalizumab has caused a serious and life-threatening disease called PML. Natalizumab is tightly controlled because of this. If you take natalizumab, you will need to enroll in a program called the Crohn's Disease–Tysabri Outreach Unified Commitment to Health (CD-TOUCH) Prescribing Program.

Taking medicine

Medicine is one of the many tools your doctor has to treat a health problem. Taking medicine as your doctor suggests will improve your health and may prevent future problems. If you don't take your medicines properly, you may be putting your health (and perhaps your life) at risk.

There are many reasons why people have trouble taking their medicine. But in most cases, there is something you can do. For suggestions on how to work around common problems, see the topic Taking Medicines as Prescribed.

Advice for women

If you are pregnant, breast-feeding, or planning to get pregnant, do not use any medicines unless your doctor tells you to. Some medicines can harm your baby. This includes prescription and over-the-counter medicines, vitamins, herbs, and supplements. And make sure that all your doctors know that you are pregnant, breast-feeding, or planning to get pregnant.


Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor if you are having problems. It's also a good idea to know your test results and keep a list of the medicines you take.

Complete the new medication information form (PDF) (What is a PDF document?) to help you understand this medication.



  1. Friedman S, Lichtenstein GR (2006). Crohn's disease. In MM Wolfe et al., eds., Therapy of Digestive Disorders, 2nd ed., pp. 785–801. Philadelphia: Saunders Elsevier.
  2. American Gastroenterological Association (2007). American Gastroenterological Association consensus development conference on the use of biologics in the treatment of inflammatory bowel disease. Gastroenterology, 133(1): 312–339.
  3. Schreiber S, et al. (2007). Maintenance therapy with certolizumab pegol for Crohn's disease. New England Journal of Medicine, 357(3): 239–250.
  4. Sandborn WJ, et al. (2007). Certolizumab pegol for the treatment of Crohn's disease. New England Journal of Medicine, 357(3): 228–238.
  5. MacDonald JK, McDonald JWD (2007). Natalizumab for induction of remission in Crohn's disease. Cochrane Database of Systematic Reviews (1).
  6. Rutgeerts P, et al. (2005). Infliximab for induction and maintenance therapy for ulcerative colitis. New England Journal of Medicine, 353(23): 2462–2476.


By Healthwise Staff
Primary Medical Reviewer Kathleen Romito, MD - Family Medicine
Primary Medical Reviewer Brian D. O'Brien, MD - Internal Medicine
Specialist Medical Reviewer Arvydas D. Vanagunas, MD - Gastroenterology
Last Revised December 8, 2010

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