For some people with ulcerative colitis, biologics are important for managing many painful symptoms, like diarrhea, abdominal pain, and fevers.
First, here’s a little refresher on why these symptoms occur in the first place. Ulcerative colitis, an inflammatory bowel disease, causes inflammation and ulcers in your colon and rectum; your specific symptoms may vary depending on where the inflammation occurs in your digestive tract. While there is no cure, treatments can reduce the inflammation and accompanying symptoms so you feel more comfortable. People with moderate to severe ulcerative colitis commonly take biologics, a class of drugs that reduce inflammation in various ways, according to the Mayo Clinic. If you’re interested in trying a biologic, then it’s a good idea to understand how these drugs could work for you.
Here are a few questions you should ask your doctor about this class of ulcerative colitis medications.
1. Why did you choose this biologic for me?
When selecting your medication, doctors consider multiple factors, ranging from your medical history to the physician’s experience prescribing a specific drug, according to Abhik Bhattacharya, M.D., an assistant professor of gastroenterology at the Icahn School of Medicine at Mount Sinai.
Doctors don’t inherently know which medications will work best for you, so they often make a judgment call based on your conversations, Stephen B. Hanauer, M.D., professor of gastroenterology and hepatology at Northwestern University, explains. “We do ‘shared decision making’ with each patient to describe the benefits and risks of each type of medication as well as how they are administered,” he tells SELF.
Cost is typically a big deciding factor, explains Dr. Hanauer. “Often the insurance company will determine which medications patients can receive,” he says.
2. Will my biologic fit my lifestyle?
Taking a biologic is a little more complex than swallowing a pill every morning since these drugs come in the form of injections. However, treatments can differ in terms of time commitment and method of delivery; some biologics are given through intravenous (IV) infusions in a process that can take several hours. Other biologics are self-injected under the skin. (You should be able to request training on injecting if your doctor prescribes this form.)
Megan Starshak, an ulcerative colitis patient and advocate for the Crohn’s and Colitis Foundation who has been using a biologic for more than a decade, tells SELF that she has to schedule time into her day for treatments. Lately, Starshak has had a home nurse administer the IV treatments. “I put work out of my head, school, and other stressors, and just kind of eat snacks, watch TV, and zone out under a blanket,” she says. “I treat it as me time.”
But not everyone is able to set aside an hours-long window for treatments every few weeks. Of course, not everyone is comfortable having a nurse in their home or visiting a public health center right now. That’s why it’s important to “really involve the patient in shared decision making” around treatment, Dr. Bhattacharya says.
3. What are the side effects?
Remember that side effects are not unique to biologics—every medication comes with its risks. But this is still a crucial element to know before deciding on any treatment, and doctors typically go over side effects before prescribing medications, Dr. Bhattacharya explains.
The most common biologic side effects include reactions at the injection site—things like pain, redness, or a rash. You also may be more susceptible to infections while taking biologics because the drugs target your immune system to lower inflammation, according to the Mayo Clinic.
If you’re worried about side effects, then you might want to ask your doctor some follow-up questions after they explain what you might be able to expect. Here are a few to consider:
- How many of your patients experience side effects?
- What are the most common side effects that your patients experience?
- How will we manage potential side effects?
From her experience, Starshak says she feels lucky that she hasn’t encountered any side effects.
4. Will biologics help me achieve remission?
Unfortunately it’s impossible for your doctor to predict if you’ll achieve remission, or be symptom-free, with a particular drug. “This is the goal of treatment—to induce and maintain remissions,” says Dr. Bhattacharya. However, your doctor may have information on the percentage of people who typically respond well to your particular biologic, he explains.
5. Will my biologic stop working, and what do I do if this happens?
Your treatment may stop working at some point for a couple of reasons, explains Dr. Hanauer. The first is if you don’t follow the recommended treatment schedule, which explains why it’s so important to choose a medication that fits your lifestyle, he says.
Sometimes your immune system produces antibodies to a biologic because it mistakes the drug for an invader. (This is similar to the way your body reacts to the common cold.) When this occurs, the biologic can’t effectively treat your symptoms. Doctors may combine a biologic with an additional immunosuppressant medication to help prevent your body from creating these antibodies, according to LeaAnn Chen, M.D., an assistant professor of medicine in the Division of Gastroenterology and Hepatology at Rutgers Robert Wood Johnson Medical School. As the name implies, immunosuppressants suppress your immune system, a process that also lowers inflammation, according to the Mayo Clinic.
It’s natural to be discouraged if your medication stops working, but know that you may be able to try a different biologic if one isn’t effective. “Not every shoe fits everyone. Many people will respond to one form of biologic and not another,” Dr. Bhattacharya says.
6. How will I know if my biologic stops working?
Usually you’ll know because your original symptoms will reemerge or get worse, Dr. Hanauer explains. For instance, you might start to feel extremely tired and have frequent diarrhea, Dr. Bhattacharya says. If symptoms like intense fatigue start to impact your day-to-day life again, he recommends calling your doctor. It’s a good idea to act as quickly as possible to avoid issues like a vitamin deficiency from an inability to absorb nutrients.
Monitoring your symptoms is just one way to tell if your medication works, according to Dr. Chen. You might need to get regular blood work so your physician can check for inflammatory markers, Dr. Bhattacharya says. If you’re worried about in-person lab visits, then it’s worth asking your doctor about how to receive this kind of care as safely as possible right now.
7. Can I take biologics if I plan to get pregnant?
Dr. Chen says that more people should feel comfortable discussing family planning if they take a biologic and want to get pregnant. Certain biologics may not be safe in pregnant people, according to the American College of Obstetricians and Gynecologists, but it’s important to weigh the benefits of any treatment against the potential risks. Talking to your doctor about all of this can help you determine if you should switch to another biologic or change your treatment entirely. “If a patient is considering trying to conceive, it’s important to bring that up early because it might help guide some decision-making on what would be the best biologic to use,” Dr. Chen says.
Related:
- Ulcerative Colitis Symptoms That Should Be On Your Radar
- 8 Questions to Ask Your Doctor After an Ulcerative Colitis Diagnosis
- Gastroenterologists Share 9 Things to Do When You Have Painful Gas