Should I use biologics or steroids for managing my UC at 34?

Question

Hello doctor,

I am a 34-year-old man diagnosed with ulcerative colitis three years ago. Lately, I have been experiencing more frequent flares with bloody stools and urgency, despite being on Mesalamine. My gastroenterologist mentioned stepping up to biologic therapy. Please tell me;

What are the pros and cons of starting biologics?
How do they compare with steroids in terms of long-term control and side effects?

Kindly help.

Answer 1

Hello,

Welcome to icliniq.com.

I read your query and can understand your concern.

Living with the unpredictability of bloody stools, urgency, and discomfort can take a real toll on your daily life, both physically and emotionally. When Mesalamine alone no longer controls inflammation, it usually means the disease has become more active, and stepping up treatment to biologic therapy is often the next logical step to protect your colon long term.

Biologic therapies, such as Infliximab (a chimeric monoclonal antibody), Adalimumab (an antitumor necrosis factor drug), or Ustekinumab (a monoclonal antibody), work by targeting specific molecules in the immune system that cause inflammation in the colon. Unlike steroids, which broadly suppress the immune system and are meant for short-term flare control, biologics are designed for long-term disease maintenance and healing of the intestinal lining. The major advantage of biologics is that they can induce and maintain remission while reducing the need for steroids, preventing steroid dependence, and many of its long-term side effects like

Bone loss.
High blood sugar.
Weight gain.
Mood changes.

However, there are a few important considerations. Biologics slightly increase the risk of,

Infections, especially tuberculosis or hepatitis, which is why your doctor will screen for these before starting treatment.
Some patients may develop infusion or injection reactions, or the body may form antibodies that reduce the drug’s effectiveness over time.

Despite these risks, most people tolerate biologics very well, and with regular monitoring, serious side effects are uncommon.

Discuss with your gastroenterologist which biologic might best suit your disease pattern and lifestyle. The goal now is not just to stop the current flare, but to achieve deep, lasting remission so you can feel healthy and confident again without constantly worrying about symptoms or flare-ups.

I hope this information helps you.

Feel free to ask further queries.

Thank you.