Saturday, December 5, 2015

{Crohn's Awareness} :: IBD and Biologics

There is no cure for Crohn's {or Ulcerative Colitis}, so there is no one specific medication for it. Over the counter medications {like anti-diarrheals, pain relievers, supplements} only focus on specific symptoms, rather than treating the inflammation in your gut. There are other antibiotics and anti-inflammatory drugs that are given at the outset of a flare to help get the inflammation under control. But these are not long-term solutions. And then there are immune system suppressors {most commonly used to treat IBD}, which reduce inflammation but, of course, target your immune system.

When I was first diagnosed with Crohn's, I was in the emergency room, so I was hooked up to an IV of antibiotics and steroids. When I got to go home, they sent me off with more antibiotics and a steroid regimen to simply get the inflammation in my intestines under control. But then I was to discuss with my doctor what a long-term treatment plan would look like. 

After much prayer, individual research, and consultation with my doctor, I decided to go with a biologic- Humira. I wasn't excited about this option, but I knew it was the best one for me. So today, I wanted to take a look at biologics, and specifically Humira, since it's the one with which I have the most experience.

What are Biologics?
Biologics are genetically engineered medications made from living organisms and their products {like proteins}. They interfere with your body's inflammatory response in IBD by specifically targeting those things in your body that play a role in increasing and decreasing inflammation. That big scary definition made me pause for sure, but it also makes me grateful for modern technology and how the Lord uses medicine and smart people.

The biologics for IBD that are on the market now {Humira, Cimzia, Remicade, Simponi, Tysabri, and Entyvio}, are considered immunosupressants, but instead of affecting your entire immune system {something that scared me}, they target the specific area of your immune system that causes the inflammation in your intestines. So my fear of having my immune system completely compromised has not been an issue. Sure, I have a weaker immune system than most and have to take extra precautions, but because my medication acts selectively, I have not been sick constantly.

Some biologics are administered intravenously {Remicade, Tysabri, Entyvio} and others are given through a subcutaneous injection {Humira, Cimzia, Simponi}. The intravenous infusions take about 2 hours to complete and are usually given every 8 weeks or so. The subcutaneous injections are usually self-administered and taken every other week or every 4 weeks, depending on the medication. I take my Humira injections every other week.

What are the Advantages of Biologics?
Biologics are the newest class of IBD drugs, and therefore benefit from the latest research. They target the specific area of your body that causes inflammation, so your entire immune system is not suppressed. Many patients experience success with achieving and maintaining remission on biologics, as they are often used after other drugs and treatments have failed. For many, the introduction of biologics has led to improved quality of life, fewer admissions to the hospital, and fewer side effects from other IBD drugs.

For me, the advantage of Humira is that it is the biologic drug that has been on the market the longest. While it is considered a "newer" therapy because it is a biologic, it has been around for the treatment of Crohn's since 1996. I realize that's not very long, but there's at least a decade of research with it, where it is a much shorter time with the other biologics. In addition, I can administer my injections myself at home {simple and convenient}, rather than having to go in to a doctor's office every 6-8 weeks. 

What are the Disadvantages of Biologics?
The main disadvantages of biologics are the high cost and the uncertainty about their long-term safety. Biologics have a hefty price tag {we're talking thousands of dollars, even with insurance- Humira costs about $3000 per month. Not kidding.}, and are often not a financial option for people. I nearly had a heart attack when I saw the price tag the first time, and I still gasp when I hear my total when I'm reordering my medication. I have to get Humira through a specialty pharmacy, and it has to be refrigerated, which adds an extra complication to traveling.

Because biologics have only been around for about a decade, we simply don't know what the long-term side effects are. They are synthetic drugs that I am purposely putting into my body, messing with biological systems. They come with their own set of {known} side effects, and I am sure there will be more. Because of biologics, I have a higher risk for tuberculosis, hepatitis B, and cancer.

When I first started taking Humira, it was rough going as my body was getting used to the medication. For one, the injection HURTS LIKE THE DEVIL. I have gotten used to it, but it still makes me curse every time. It's 10 seconds of stinging torture, but then it's over...for 2 weeks. I still sometimes experience redness, swelling, and itchiness at the injection site. At the beginning, I did get sick a lot. I also started losing my hair {that was a terrifying realization}. But once my body got used to the medication, the hair loss slowed, and it eventually got better. I got A LOT of UTI's; another side effect related to a compromised immune system. But eventually, my body adjusted, and I don't experience much of the side effects anymore, other than injection site issues.

Why Did I Choose Biologics?
After listing the disadvantages of biologics, it's a wonder anyone even considers taking them. Trust me, these things were not considered flippantly when we were making decisions about my treatment plan. These risks may sound scary {and they are}, but you have to understand the risks involved with NOT treating Crohn's, and then decide the best course of action for you individually. For me, these scary side effects and unknowns far outweighed the risks of the complications of Crohn's. 

I was faced with the reality that my body was broken in such a way that could cause major complications. It wasn't something that I could ignore and simply hope would go away; that's just not how it works. In order to be as healthy as possible, I had to pick a treatment plan that would get me healthy. For me, that treatment plan included medication. Based on what is known about Crohn's, the idea of targeting a specific inflammatory response made the most sense to me. And the current research shows the most success with biologics. 

Another reason I chose Humira over other treatment plans is because of our desire to grow our family. We needed a treatment that would help me achieve and maintain remission, but would also be safe during pregnancy. Humira is a category B drug, meaning that animal studies have not demonstrated a risk to the baby, and there are not adequate studies in pregnant women. There are cautions for taking Humira while nursing, because it is unknown whether the drug passes to the baby in breast milk {a bridge we will cross when we get there}. So it's not necessarily unsafe, but a detailed discussion with your doctor should be had. After much prayer and discussion with my doctors {both GI and fertility}, my best chance at a healthy pregnancy was for me to actually get {and stay} on Humira. 

The Lord has been faithful to provide what we have needed to cover the cost of my medication. We have had to make major adjustments in our budget to account for it, but unfortunately, that is just reality when you have an incurable, chronic disease. And because of the success I have experienced on the medication, it has saved me thousands in hospital bills. So for me, that benefit has been worth the financial sacrifice. 

And as for the health concerns, I leave that in the Lord's hands. I really don't have any other option. For me, the combination of diet, medication, and stress reduction have helped me achieve remission. I have stayed out of the hospital since my diagnosis and am able to live a relatively normal and active life. So I am incredibly grateful for that. I know it may not last forever, and Humira may not be effective for me forever, but I am thankful for the time it has given me. Biologics may not be for everywhere, but Humira has certainly helped me.

*Research/information taken from NCBIUCSF Medical Center, and CCFA

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