Center for Inflammatory Bowel Disease Treatment and Research
Biologics (Remicade and Humira) in IBD
Patients with Crohn’s disease or ulcerative colitis sometimes require treatment with a group of medications called biologics, or anti-tumor necrosis factor antibodies (anti TNF antibodies for short). Anti-TNF antibodies are usually used when inflammatory bowel disease does not respond to other medications, or when other medications cause side-effects. Anti-TNF antibodies work by blocking inflammatory chemicals in the blood, and may also decrease the number of immune system cells in thebody. Remicade (infliximab) has been used since 1999 to treat inflammatory bowel disease. It has been FDA approved for the treatment of Crohn’s disease in adults and children, and ulcerative colitis in adults. Humira (adalimumab) has also been shown to be effective in treating Crohn’s disease, and has been FDA approved for treatment of Crohn’s disease in adults.
As with most medications, most studies of anti-TNF antibodies have been conducted on adults. Pediatric studies suggest anti-TNF medications are very effective in treating children with Crohn’s disease. Approximately 70-80% of children with Crohn’s disease treated with anti TNF agents will improve. Beneficial effects that may be observed include less active disease, less diarrhea, less abdominal pain, closure of fistulas, less need for steroids, improved appetite, and improved growth. The benefit of Remicade in ulcerative colitis has been demonstrated in both adults and children; about 50%-75% of children will show improvement in their symptoms.
As with any medications, there are also risks involved. Approximately 10% of patients will develop infusion reactions to Remicade, which usually consist of shortness of breath, rashes, or fever. Serious infections, including tuberculosis, have been reported in less than 1% of patients receiving ant-TNF medications. We routinely perform a TB skin test before starting Remicade or Humira, and we consider obtaining a chest x-ray in anyone with respiratory symptoms. Sometimes, lowering of the white blood cell count is seen, so we routinely monitor blood counts with each infusion/injection. Other rare serious side effects that have been reported include brain inflammation and serious liver disease. These occur in fewer than 0.1% (1/1000) patients.
There is also a reported risk of lymphoma (a tumor of the lymph glands) in patients receiving anti-TNF therapy. While the precise risk is unknown, lymphoma occurs in approximately 1/500 to 1/1000 adults with rheumatoid arthritis treated with these medications. The precise risk in children is unknown.
In summary, anti TNF agents are effective drugs that are generally well tolerated, and improve the health in most patients with inflammatory bowel disease. Most patients tolerate these medications very well. However, a small number (less than 1%) of patient treated will develop serious complications of treatment. Alternatives to anti TNF treatment in some patients may include other immunosuppressive medications, surgery, and elemental diets (special formulas usually given via a feeding tube). Your physician has considered benefits, risks, and alternative treatments into account, and has recommended anti TNF treatment because he feels it is the best treatment option at this time. If you require additional information, please don’t hesitate to ask any questions of your physician.