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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).
These medicines are used to start remission (a period without symptoms) in people who have Crohn's disease or ulcerative colitis. They are also used to help someone stay in remission.
These medicines are usually used when the disease doesn't get better with other medicines. They may also be used in people who cannot take other medicines.
Infliximab may also be used to treat
abnormal connections (fistulas) between the intestines and
organs in moderate-to-severe Crohn's disease.
In multiple studies, almost 70 out of
100 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
In one study, between 60 and
70 out of 100 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
In one study, almost 20 out of 100 people with ulcerative colitis were better after 8 weeks of using adalimumab.7 This drug hasn't been studied as much for ulcerative colitis compared to other medicines. Doctors still don't know a lot about how well it works.
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:
Call 911 or other emergency services right away if you have:
Call your doctor right away if you have:
Common side effects of this medicine include:
Warnings about serious side effects of biologics have
been issued. The U.S. Food and Drug Administration (FDA) and the drug's
manufacturers have warned about:
In very few cases, natalizumab has caused a serious and
life-threatening brain infection called PML (progressive multifocal leukoencephalopathy). 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)
Your risk for getting PML increases if you have any of these risk factors:
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.
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.
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.
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.
Schreiber S, et al. (2007). Maintenance therapy with
certolizumab pegol for Crohn's disease. New England Journal of Medicine, 357(3): 239–250.
Sandborn WJ, et al. (2007). Certolizumab pegol for the
treatment of Crohn's disease. New England Journal of Medicine, 357(3): 228–238.
MacDonald JK, McDonald JWD (2007). Natalizumab for
induction of remission in Crohn's disease. Cochrane Database of Systematic Reviews (1).
Rutgeerts P, et al. (2005). Infliximab for induction and maintenance therapy for ulcerative colitis. New England Journal of Medicine, 353(23): 2462–2476.
Reinisch W, et al. (2011). Adalimumab for induction of clinical remission in
moderately to severely active ulcerative colitis:
Results of a randomised controlled trial. Gut, 60(6): 780–787.
November 5, 2012
E. Gregory Thompson, MD - Internal Medicine & Arvydas D. Vanagunas, MD - Gastroenterology
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