Biologics for Crohn's Disease: 6 Ways They May Benefit You
As someone living with Crohn's disease, you've likely heard about biologics. These are a type of prescription drug administered via an injection or intravenous (IV) drip. They manage inflammation by blocking certain proteins or chemical pathways.
You may have thought about trying them yourself. Here are six reasons this advanced type of treatment may be helpful for you and what you may want to consider.
Your Crohn's isn't responding to traditional treatments
Perhaps you've been taking different Crohn's disease medications, such as steroids and immunomodulators, for a while now. However, you're still having flare-ups several times a year.
American College of Gastroenterology guidelines strongly recommend taking a biologic agent if you have moderate to severe Crohn's disease that's resistant to steroids or immunomodulatory therapy.
Your doctor may also consider combining a biologic with an immunomodulator, even if you haven't tried those drugs separately yet.
You have a new diagnosis
Traditionally, treatment plans for Crohn's disease involved a step-up approach. Less expensive drugs, like steroids, were tried first, while more expensive biologics were a last resort.
More recently, guidelines have suggested a top-down approach with a new diagnosis. This is when stronger drugs are tried first, as evidence has pointed to better results when biologic treatments are started right after diagnosis.
A 2021 review of 31 trials found that for people with moderate to severe Crohn's disease, the combination of a biologic drug (infliximab) with a non-biologic drug (azathioprine) had the most promising results for managing symptoms.
The 2025 ACG guidelines also recommend the combination of both drugs over either individually.
You experience a complication known as fistulas
Fistulas are abnormal connections between body parts. In Crohn's disease, a fistula can occur when an ulcer extends through your intestinal wall, which connects your intestine and skin, or your intestine and another organ.
If a fistula becomes infected, it can be life threatening. If you have a fistula, your doctor may prescribe biologics known as TNF inhibitors because they're so effective.
The Food and Drug Administration (FDA) has approved biologics specifically to treat Crohn's disease with fistulas and to maintain fistula closure.
You want to maintain remission
Corticosteroids are known to bring about remission but aren't able to maintain that remission. If you've been taking steroids for 3 months or longer, your doctor may suggest you try a biologic instead.
Clinical studies show that anti-TNF biologics are able to maintain remission in people with moderately severe Crohn's disease.
Researchers note that the benefits of these drugs in maintaining remission generally outweigh the risks for most people.
Dosing may only be once per month
The thought of an injection may be scary, but after the initial few doses, most biologics are administered only once every two months. This may be once every month if your condition does not respond. However, it may be reassuring to know that the needle is very small, and the medication is injected just under your skin.
Most biologics are also offered in the form of an auto-injector, which means you can get the injections without ever seeing a needle. You can even give yourself certain biologics at home after you're trained properly on how to do so. Some self-administered biologics may need to be given biweekly, such as Humira and Entyvio.
They may have fewer side effects than steroids
Corticosteroids, such as prednisone or budesonide, work by suppressing the entire immune system.
Biologics, on the other hand, work in a more selective way by targeting specific proteins in your immune system that are proven to be associated with Crohn's inflammation. As they are more precise, they typically have fewer side effects than corticosteroids.
However, almost all drugs carry the risk of side effects. For biologics, the most common side effects are related to how they're administered. You might experience minor irritation, redness, pain, or a reaction at the site of injection.
There's also a slightly higher risk of infection, but the risk is not as high as with other drugs, such as corticosteroids.
»MORE: What to know about switching to biologics
Biologics safety
The first biologic for Crohn's disease was approved in 1998, so biologics have quite a bit of experience and safety testing to show for themselves.
You may be hesitant to try a biologic because you heard they were 'strong' drugs, or you're concerned about the high costs. However, while biologics are considered a more aggressive treatment option, they're also more targeted drugs, and they work very well.
Unlike some older treatments for Crohn's disease that weaken the whole immune system, biologic drugs target specific inflammatory proteins known to be involved in Crohn's disease. In contrast, corticosteroid drugs suppress your entire immune system.
However, you'll still want to consider all side effects and discuss with your doctor whether biologics are the best option for you.
Choosing a biologic
Before biologics, there were few treatment options aside from surgery for people with severe Crohn's disease. Now, there are several options:
adalimumab (Humira, Exemptia)
certolizumab pegol (Cimzia)
infliximab (Remicade, Remsima, Inflectra)
natalizumab (Tysabri)
ustekinumab (Stelara)
vedolizumab (Entyvio)
risankizumab (Skyrizi)
guselkumab (Tremfya)
You'll have to work with your insurance company to find out whether a particular biologic is covered under your plan.
Takeaway
Biologic medications are targeted treatment options for Crohn's disease and other autoimmune conditions. They are typically strong but effective and may have fewer side effects than some other traditional treatments.
However, like with all drugs, there are things you'll want to consider to determine if this option is right for you. Certain factors may mean this type of treatment is suitable for you, but it'll depend on your specific circumstances. Speaking with your doctor can help you figure out if biologics are a good option.
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