Comparing 6 Biologic Drugs Used to Treat IBD

Differences in Administration, Efficacy and Conditions Treated

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Biologics are a newer class of drugs used to treat the inflammation that is caused by inflammatory bowel disease (IBD). This is a broad range of medications that each work in slightly different ways with different standards of administration and dosing. Some are approved to treat just one form of IBD, while others are used to treat both Crohn's disease and ulcerative colitis.

Infusion Center
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Because biologic drugs temper the immune response, people taking them are prone to certain infections. It's important, therefore, to take steps to reduce your vulnerability. People with IBD should receive vaccinations, ideally before starting a biologic, although many immunizations can also be given while taking a biologic.

According to 2020 guidelines, a biologic drug should be used first-line for treatment (rather than waiting for other treatments to fail) in people with moderate to severe ulcerative colitis.

Many factors are taken into consideration when choosing the right biologic. This can include the type and severity of your disease, your treatment history, and your insurance coverage, among other factors. Doctors will take all of these factors into consideration when making a recommendation for treatment.

Pregnancy Considerations

Animal studies have not shown a risk of fetal harm associated with most biologics, but there are no good-quality studies available in humans. Generally speaking, their benefits in IBD treatment are expected to outweigh any possible risks.


Cimzia (certolizumab pegol) is a tumor necrosis factor (TNF) blocker that was approved in 2008 to treat Crohn's disease. It was approved by the U.S. Food and Drug Administration (FDA) in 2009 for the treatment of rheumatoid arthritis and for psoriatic arthritis and ankylosing spondylitis in 2013.

Cimzia is usually given by injection with a prefilled syringe at home. Cimzia is given with two injections, which are first administered in a loading dose at weeks 0, 2, and 4. After that, the two injections are given every 4 weeks. Another form of Cimzia is a powder that is mixed and then injected at a doctor's office.

Side effects that occur most commonly with this drug are upper respiratory tract infections (like a cold), viral infections (like the flu), rashes, and urinary tract infections.

Key Points About Cimzia

  • Cimzia is approved to treat Crohn's disease.
  • Cimzia is usually given at home by injection.
  • Cimzia is given initially three times in a series of two injections, two weeks apart, followed by two injections every four weeks.
  • Common side effects include respiratory infections, viral infections, rashes, and urinary tract infections.
  • If you are pregnant or plan to become pregnant, you and your doctor should decide if you should take Cimzia.  
  • A low amount of Cimzia may pass into the breastmilk.
  • Cimzia needs to be refrigerated.


Entyvio (vedolizumab), approved by the FDA in May 2014, is a gut-homing α4β7 integrin antagonist. It is thought to work by binding to α4β7 integrin, which prevents the integrin from causing inflammation. Entyvio is approved for use in adults who have Crohn's disease or ulcerative colitis.

Entyvio is always given by infusion, either in a doctor's office, at a hospital, or in an infusion center. The loading schedule for Entyvio is 3 infusions at weeks 0, 2, and then 6. After that, infusions are given about every 8 weeks.

Some of the potential side effects include a cold, upper respiratory tract infection (the flu, bronchitis), headache, joint pains, nausea, fever, fatigue, cough, back pain, rash, itching, sinus infection, throat pain, and extremity pain.

Key Points About Entyvio

  • Entyvio is approved for ulcerative colitis and Crohn's disease.
  • Entyvio is given by infusion in three starting doses, and then every eight weeks.
  • Common side effects include infections (a cold, the flu, bronchitis, sinus infection); pain in the joints, back, throat or extremities; symptoms of nausea, fever, fatigue, cough, or itching; and a rash.
  • If you are pregnant or plan to become pregnant, you and your doctor should decide if you should take Entyvio.
  • It's not currently known if Entyvio passes into breastmilk.


Humira (adalimumab) is another monoclonal antibody and TNF inhibitor that is used to treat people with IBD. It is approved for adults and children over the age of 6 that have ulcerative colitis or Crohn's disease. Humira was initially approved in 2002 and expanded for use in Crohn's disease in 2007 and ulcerative colitis in 2012.

Humira can be given at home through an injection. Patients are trained on how to give themselves the injection (or it could be done with help from a family member or friend).

Some people with Humira may have what's called an injection site reaction, which is swelling, pain, itching or redness at the place where the drug is injected. This can usually be treated at home with ice or antihistamine medications (changing injection sites every week also helps).

Key Points About Humira

  • Humira is approved for both Crohn's disease and ulcerative colitis.
  • Humira is given at home by self-injection.
  • Humira is started with 4 injections, followed by 2 injections 2 weeks later, and then 1 injection every other week.
  • Common side effects include pain or irritation at the injection site and headache, rash, and nausea.
  • If you are pregnant or plan to become pregnant, you and your doctor should decide if you should take Humira.
  • Infants born to mothers receiving Humira should not receive live vaccines for six months.
  • Humira needs to be refrigerated.


Remicade (infliximab) was the first biologic therapy approved for use in people with IBD, approved back in 1998. It could be used to treat Crohn's disease or ulcerative colitis, and it is also approved for kids as young as 6, in certain circumstances. Remicade is thought to work in people with IBD because it is a monoclonal antibody that inhibits TNF, which is a substance that creates inflammation in the body.

Remicade is given to patients through an IV. This could be done in a doctor's office, but more often occurs in an infusion center, which are specialized facilities designed to administer medications by IV.

Key Points About Remicade

  • Remicade is given by IV.
  • Remicade is approved for Crohn's disease and ulcerative colitis.
  • Three starting doses are given (after the first dose, the second is two weeks later, third is four weeks after that).
  • After the starting doses, it's given about every eight weeks (sometimes sooner if needed).
  • Common side effects are abdominal pain, nausea, fatigue, and vomiting.
  • If you are pregnant or plan to become pregnant, you and your doctor should decide if you should take Remicade.


Simponi (golimumab) is a TNF inhibitor that's approved for treating ulcerative colitis. Simponi was approved first in 2009 to treat rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis. In 2013 it was approved to treat ulcerative colitis. Ankylosing spondylitis is a condition that can be associated with ulcerative colitis, which means that this medication could be used to treat both disorders.

A newer formulation called Simponi Aria was approved for use in 2019 and differs in part because it is delivered intravenously rather than subcutaneously. Because of this, it requires less frequent dosing than Simponi.

Simponi is given at home, so patients are trained by a healthcare provider on how to inject themselves (either by themselves or with help).

Some of the adverse reactions to Simponi are getting infections that cause illnesses like a cold, symptoms like a sore throat or laryngitis, and viral infections like the flu. Having redness, pain, and itchiness at the injection site, often treated with ice and antihistamines, is another potential adverse reaction.

Key Points About Simponi

  • Simponi is approved to treat ulcerative colitis.
  • Simponi is given by injection at home.
  • Simponi is started with two injections, followed by one injection two weeks later, and one injection every four weeks thereafter.
  • Common side effects include pain or irritation at the injection site and upper respiratory or viral infections.
  • If you are pregnant or plan to become pregnant, you and your doctor should decide if you should take Simponi.
  • It's not currently known how Simponi will affect a nursing infant.
  • Simponi must be refrigerated.


Stelara (ustekinumab) is a fully human monoclonal immunoglobulin antibody. It was first approved in 2008 as a treatment for plaque psoriasis, followed by approval in 2016 to treat Crohn's disease and in 2019 to treat ulcerative colitis. Stelara works to decrease the inflammation Crohn's disease causes by targeting interleukin (IL)-12 and IL-23, which are thought to play a role in the development of inflammation in the intestine.

The first dose of Stelara is given by infusion, in an infusion center or a doctor's office. After that first infusion, Stelara can be taken at home with an injection that's given every 8 weeks. Patients can give themselves the injection after being trained by a healthcare provider.

Some of the more common side effects seen in people with Crohn's disease who take Stelara include vomiting (during the first infusion), pain or redness at the injection site, itching, and infections such as a cold, a yeast infection, bronchitis, urinary tract infection, or sinus infection.

Key Points About Stelara

  • Stelara is approved to treat Crohn's disease.
  • The loading dose of Stelara is given by infusion and thereafter is given by injections at home.
  • People taking shots for allergies should talk to their doctor about possible allergic reactions and Stelara.
  • Common side effects include infections, injection site reactions, and vomiting.
  • If you are pregnant or plan to become pregnant, you and your doctor should decide if you should take Stelara.
  • It's thought that Stelara does pass into breastmilk.
  • Stelara must be refrigerated.
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10 Sources
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