10 Things to Know About Biologics for Ulcerative Colitis
Digestive HealthUlcerative Colitis
Explore This Topic

10 Things to Know About Biologics for Ulcerative Colitis

Biologics are a key treatment option for ulcerative colitis, especially if other treatments haven’t worked for you. Here’s what you should know before you start this therapy.
10 Things to Know About Biologics for Ulcerative Colitis
Andrey Popov/Getty Images
By
Updated on August 25, 2025
by

If you have moderate to severe ulcerative colitis (UC) and haven’t found enough relief from traditional medications, your doctor may talk to you about biologics.

These newer drugs, which include adalimumab (Humira) and infliximab (Remicade), work differently by targeting inflammation that triggers UC symptoms. The goal is to help you achieve and stay in remission.

Taking a biologic is a big step, and this type of treatment may not be suitable for everyone. That’s why it’s important to understand the basics before you start. Here are 10 key things to know about biologic drugs for UC.

1. Biologics Aren’t Always Considered a First-Line Treatment

Although many doctors believe it’s better to start a biologic drug sooner rather than later, it may not be your first UC treatment if you have mild disease.

According to treatment guidelines from the American College of Gastroenterology, the standard approach often starts with other medications first.

 Biologics are generally recommended for people with moderate to severe UC who haven’t found relief with conventional therapies like aminosalicylates.

“The current indications for biologics in ulcerative colitis are for people who haven’t responded to traditional medications or are dependent on corticosteroids to relieve their symptoms,” says Thomas Ullman, MD, a professor of medicine in the division of gastroenterology at Mount Sinai in New York City and the director of the Westchester branch of Mount Sinai’s Susan and Leonard Feinstein Inflammatory Bowel Disease Clinical Center.

For some people with very active or severe disease from the outset, a doctor may recommend starting a biologic earlier in the treatment plan. This decision depends on your specific symptoms and the severity of your inflammation, among other factors.

2. Biologics Are Targeted Medications

Unlike older medications that have wide-ranging effects on the immune system, biologics are engineered to block specific proteins that cause inflammation. They’re typically grouped by which inflammatory pathway they target.

  • Anti-Tumor Necrosis Factor (TNF) Agents This is the oldest class of biologics for UC.

     They work by neutralizing a protein called TNF-alpha. This group includes infliximab (Remicade), adalimumab (Humira), and golimumab (Simponi).
  • Integrin Receptor Antagonists This type of biologic works more selectively in the gut. Vedolizumab (Entyvio) prevents inflammatory cells in the bloodstream from entering your colon tissue.

  • Interleukin Inhibitors This class of biologics blocks inflammatory messengers called interleukins. Ustekinumab (Stelara) targets two proteins, interleukin-12 (IL-12) and interleukin-23 (IL-23).

     Newer options like risankizumab (Skyrizi), guselkumab (Tremfya), and mirikizumab (Omvoh) block only the IL-23 pathway.

5 Complications of Ulcerative Colitis

Ulcerative colitis is an autoimmune disease and a form of IBD. Complications from UC affect more than just the digestive track. Here are some things to watch out for.
5 Complications of Ulcerative Colitis

Next up video playing in 10 seconds

3. Biologics Are Given by Injection, Infusion, or Both

Biologic therapies are given either as a subcutaneous injection (a shot under the skin) or an intravenous (IV) infusion (through a vein).

 The method and frequency depend on the specific drug:
  • At-Home Injections Some biologics are taken only as a shot, which you or a loved one can learn to administer at home. After the initial “starter dose,” these are typically taken every two to four weeks. Examples include adalimumab (Humira) and golimumab (Simponi).

  • Combined At-Home and IV Infusion Many newer biologics, including ustekinumab (Stelara), risankizumab (Skyrizi), and mirikizumab (Omvoh), use a two-step approach. You receive a single starter dose through a one-time IV infusion, and all subsequent maintenance doses are administered as at-home shots. Depending on the drug, these shots are taken every four to eight weeks.

  • Choice of Infusion or Injection Some drugs offer more flexibility for maintenance therapy. For example, after induction, vedolizumab (Entyvio) can be taken as either a 30-minute IV infusion every eight weeks or as an at-home shot every two weeks. Similarly, infliximab (Remicade) is available as either an IV infusion or a subcutaneous shot for maintenance.

4. Biologics May Be Used in Combination With Other UC Medications

“A biologic medication combined with a traditional ulcerative colitis drug may work better than either drug alone,” Dr. Ullman says, but two biologics shouldn’t be taken together because of an increased risk of complications.

A common strategy is to pair an anti-TNF biologic with an immunomodulator. This can help the biologic work more effectively and reduce the likelihood of your body developing antibodies against it.

5. Biologics May Take Time to Work

When you start taking an anti-TNF drug, it may take up to eight weeks before you notice any improvement in your UC symptoms. While some people notice an immediate improvement, the possibility of a delayed effect means you’ll need to continue your treatment for several weeks before you determine it isn't effective.

6. You May Need to Change Your Dose or Try Different Biologics

If a biologic drug isn’t providing enough relief, it doesn’t mean you’re out of options. Your doctor may first try to adjust your treatment by increasing the dose or having you take it more frequently.

If that doesn’t work, the next step is often switching to a different medication. For example, if you don’t have success with an anti-TNF biologic, drugs like ustekinumab (Stelara) or certain Janus kinase (JAK) inhibitors like tofacitinib (Xeljanz) or upadacitinib (Rinvoq) may be recommended over other options. Ultimately, choosing your next medication is a personal decision that you and your doctor will make together based on your health history and treatment goals.

7. Biologic Therapy Can Lead to Long Periods of Remission

Biologics are effective for both inducing and maintaining remission in people with moderate to severe UC.

 “We’re seeing fewer hospital admissions, fewer surgeries, and less disability from ulcerative colitis with the use of these drugs,” says Ullman.

8. Biologics May Become Less Effective Over Time

It’s possible for a biologic medication that initially worked well for you to become less effective over months or years. This is known as a loss of response, and it’s a known challenge in the long-term management of UC.

If this happens, you have options. According to treatment guidelines, if you lose response to an anti-TNF drug, the preferred next step is often to switch to a drug from a different class with higher or intermediate efficacy.

9. Biologics Have Some Side Effects and Long-Term Risks

Common side effects of biologic drugs often relate to how they’re given. You may experience injection site reactions, including itching, rashes, or swelling.

Biologics change the way your immune system works, so the biggest risk is a higher susceptibility to infection, Ullman says. For this reason, your doctor will screen you for potential dormant infections like tuberculosis (TB) or hepatitis B before you start treatment, as a biologic could reactivate them.

 It’s also important to stay up-to-date on vaccines, including the flu shot, pneumonia vaccine, and COVID-19 vaccine.

While anti-TNF medications do not appear to have an increased risk of a type of blood cancer called lymphoma when used on their own, combination therapy (use of multiple drugs) and previous use of thiopurine medications have been linked to a small, but measurable, increase in lymphoma risk.

10. Biologics Are Expensive

Biologic drugs can be very expensive. While health insurance covers a portion of the cost, out-of-pocket expenses can still be a major consideration. It’s important to talk with your insurance provider and your doctor’s office to understand what you can expect to pay.

“In most cases, insurance companies do cover biologics, and most drug companies offer financial assistance programs to help cover the cost,” Ullman says.

To help manage costs, a growing number of “biosimilar” drugs are now available. According to the U.S. Food and Drug Administration (FDA), a biosimilar is a biologic that’s similar to an existing, FDA-approved biologic. There are no clinically meaningful differences between biologics and biosimilars in terms of safety and efficacy.

Today, multiple FDA-approved biosimilars are available for many of the most common biologics used for UC, including infliximab and adalimumab.

The Takeaway

  • For people with moderate to severe ulcerative colitis that hasn’t responded to other medications, biologic drugs offer a targeted way to control the underlying inflammation and lead to long-term remission.
  • There are many different types of biologics that work in different ways, and it can take up to two months or more to feel the full effects of a new treatment.
  • If one biologic becomes less effective over time, guidelines now provide a clear strategy for switching to a different medication that may work better for you.
  • Because these drugs affect your immune system, they have some side effects and risks, most notably an increased susceptibility to infection. Be sure to discuss the specific benefits and risks of each option with your doctor to make a shared decision about your care.

Resources We Trust

Additional reporting by Ashley Welch and Tabitha Britt.

EDITORIAL SOURCES
Everyday Health follows strict sourcing guidelines to ensure the accuracy of its content, outlined in our editorial policy. We use only trustworthy sources, including peer-reviewed studies, board-certified medical experts, patients with lived experience, and information from top institutions.
Resources
  1. Kim ES. Infliximab versus Adalimumab, Which One Is Better for Ulcerative Colitis? Gut and Liver. March 15, 2021.
  2. Siegel CA et al. Treatment Pathways Leading to Biologic Therapies for Ulcerative Colitis and Crohn's Disease in the United States. Clinical and Translational Gastroenterology. February 12, 2020.
  3. Ulcerative Colitis. Mayo Clinic. November 22, 2024.
  4. Wang Y et al. Understanding Patient Journey in Ulcerative Colitis Prior to Biologic Initiation: A 5-Year Exploration. BMC Gastroenterology. March 17, 2021.
  5. Juillerat P et al. Positioning Biologics in the Treatment of IBD: A Practical Guide – Which Mechanism of Action for Whom? Current Research in Pharmacology and Drug Discovery. May 5, 2022.
  6. Vedolizumab. Crohn’s & Colitis UK. May 2025.
  7. Uchida G et al. Real-World Effectiveness of Ustekinumab for Patients With Ulcerative Colitis: A Systematic Review and Meta-Analysis. Nagoya Journal of Medical Science. August 2023.
  8. Jonaitis L et al. Intravenous Versus Subcutaneous Delivery Of Biotherapeutics In Ibd: An Expert’s And Patient’s Perspective. BMC Proceedings. December 9, 2021.
  9. Adalimumab (Subcutaneous Route). Mayo Clinic. March 1, 2025.
  10. Golimumab (Intravenous Route, Subcutaneous Route). Mayo Clinic. February 1, 2025.
  11. Colquhoun M et al. Ustekinumab. StatPearls. March 27, 2023.
  12. Risankizumab-rzaa (Injection Route). Mayo Clinic. February 1, 2025.
  13. Mirikizumab-mrkz (Intravenous Route, Subcutaneous Route). Mayo Clinic. March 1, 2025.
  14. Highlights of Prescribing Information. U.S. Food and Drug Administration. April 2024.
  15. Fatima R et al. Infliximab. StatPearls. March 21, 2024.
  16. Singh S et al. AGA Living Clinical Practice Guideline on Pharmacological Management of Moderate-to-Severe Ulcerative Colitis. Gastroenterology. December 2024.
  17. Fact Sheet: Biologics. Crohn’s & Colitis Foundation.
  18. Awan H et al. The Efficacy of Currently Licensed Biologics for Treatment of Ulcerative Colitis: A Literature Review. Cureus. April 15, 2023.
  19. Savelkoul EH et al. Systematic Review and Meta-analysis: Loss of Response and Need for Dose Escalation of Infliximab and Adalimumab in Ulcerative Colitis. Inflammatory Bowel Diseases. October 2023.
  20. Biologics (Biologic Medicine). Cleveland Clinic. August 9, 2024.
  21. Maeda T et al. Tuberculosis screening for patients on biologic Medications: A Single-Center experience and Society guideline Review, Monroe County, New York, 2018–2021. Journal of Clinical Tuberculosis and Other Mycobacterial Diseases. June 22, 2024.
  22. Fernández-Prada M et al. Immunogenicity of the hepatitis B vaccine adjuvanted with AS04C in patients with biological therapies. Vaccine. January 16, 2023.
  23. Looking After Yourself While You Are on Biologics or Biosimilars or Skin Conditions (Self-Care). National Health Service. January 15, 2024.
  24. Dahmus J et al. Risk of Lymphoma Associated with Anti-TNF Therapy in Patients with Inflammatory Bowel Disease: Implications for Therapy. Clinical and Experimental Gastroenterology. September 15, 2020.
  25. Biosimilar and Interchangeable Biologics: More Treatment Choices. U.S. Food and Drug Administration. August 17, 2023.
  26. Biosimilars: What You Should Know. Crohn’s & Colitis Foundation.
Meet Our Experts
See Our Editorial PolicyMeet Our Health Expert Network

Yuying Luo, MD

Medical Reviewer

Yuying Luo, MD, is an assistant professor of medicine at Mount Sinai West and Morningside in New York City. She aims to deliver evidence-based, patient-centered, and holistic care for her patients.

Her clinical and research focus includes patients with disorders of gut-brain interaction such as irritable bowel syndrome and functional dyspepsia; patients with lower gastrointestinal motility (constipation) disorders and defecatory and anorectal disorders (such as dyssynergic defecation); and women’s gastrointestinal health.

She graduated from Harvard with a bachelor's degree in molecular and cellular biology and received her MD from the NYU Grossman School of Medicine. She completed her residency in internal medicine at the Icahn School of Medicine at Mount Sinai, where she was also chief resident. She completed her gastroenterology fellowship at Mount Sinai Hospital and was also chief fellow.

See full bio
Chris Iliades

Chris Iliades, MD

Author

Chris Iliades, MD, is a full-time freelance writer based in Boothbay Harbor, Maine. His work appears regularly on many health and medicine websites including Clinical Advisor, Healthgrades, Bottom Line Health, HeathDay, and University Health News. Iliades also writes a regular blog for The Pulse, a website for fetal health and pregnancy.

Iliades is board-certified in Ear, Nose and Throat and Head and Neck Surgery. He practiced clinical medicine for 15 years and has also been a medical director for diagnostic research and a principal investigator for clinical research before he turned to full-time medical writing.

See full bio
See Our Editorial PolicyMeet Our Health Expert Network