For further information please download the full patient publication from Crohn’s and Colitis UK

WHAT IS A BIOLOGICAL DRUG?

Biological drugs are made from proteins and other substances which occur in nature. They are produced by a biological rather than chemical process – for example they can be created inside living cells. Biological drugs are a lot larger in size and more complicated than normal chemical drugs used in IBD, such as steroids, 5ASAs and azathioprine.

WHAT BIOLOGICAL DRUGS ARE USED IN IBD?

There are several different biological drugs used in IBD. These are:

• Infliximab (brand names Remicade and the biosimilars Inflectra and Remsima)

• Adalimumab (brand name Humira)

• Vedolizumab (brand name Entyvio)

• Golimumab (brand name Simponi)

• Ustekinumab (brand name Stelara)

The two most common biological drugs currently used in IBD are infliximab and adalimumab. These are referred to as ‘anti-TNF drugs’ because they work by targeting a protein in the body called TNF alpha. This protein is found in everyone’s blood as part of the body’s response to infection. However, in people with IBD, too much TNF alpha is produced, and this causes excessive inflammation. Biological drugs such as infliximab and adalimumab block the action of TNF alpha, and reduce inflammation. There is also another newer anti-TNF drug called golimumab, which is currently less widely used.

Vedolizumab works in a different way to the anti-TNF drugs, because it is a ‘gut-selective integrin blocker’. White blood cells are made by the immune system to fight against infection. However, in Crohn’s Disease and Ulcerative Colitis, overproduction of white blood cells leads to inflammation – vedolizumab works by stopping the white blood cells from entering the lining of the gut. This means that the drug only targets the gut, rather than the whole of the body like the anti-TNF drugs do, and may cause fewer side effects.

Ustekinumab is known as an “anti-Interleukin” because it targets the proteins interleukin-12 (IL-12) and interleukin-23 (IL-23). These are increased in IBD and contribute to ongoing inflammation in the digestive system. Ustekinumab binds to both IL-12 and IL-23 which prevents them from working, helping to relieve inflammation and symptoms. Ustekinumab is an ‘immunosuppressant’ because it dampens down the activity of the immune system.

WHAT ARE THESE DRUGS USED FOR?

Infliximab, adalimumab, vedolizumab, golimumab and ustekinumab are all used to treat people with IBD.

• Infliximab and adalimumab are licensed for use in adults and children with moderate to severe active Crohn’s Disease where other drugs such as immunosuppressants and steroids have not worked or are unsuitable. They are also a possible treatment for moderate to severe Ulcerative Colitis if conventional therapy hasn’t worked or isn’t suitable.

• Golimumab is licensed for use in adults with moderate to severe Ulcerative Colitis who have failed to respond to, or have not tolerated, other treatments.

• Vedolizumab has been recommended by NICE (National Institute for Health and Care Excellence) as a treatment option for adults with moderate to severe Ulcerative Colitis. It has also been recommended for people with moderate to severe Crohn’s Disease after other treatments including either infliximab or adalimumab have not worked well enough or are unsuitable.

• Ustekinumab is a possible treatment for adults with moderate to severe active Crohn’s Disease. It may be given if non-biological therapies or tumour necrosis factor (TNF) alpha inhibitors haven’t worked or aren’t suitable.

For more detailed information please download the full patient publication from Crohn’s and Colitis UK

© Crohn’s and Colitis UK 2018