Can biologic injections help manage my ulcerative colitis?

Hello,

Welcome to icliniq.com.

I understand your concern.

I hope you are doing well, and the fact that you continue to have bloody diarrhea, cramps, weight loss, and an elevated C-reactive protein despite Mesalamine tells us that the inflammation in your colon is still active. The need to restart steroids each time you try to stop them means your disease is what we call steroid-dependent.

This does not necessarily mean it is severe in terms of immediate complications, but it does mean that your current maintenance therapy is not strong enough to keep the disease in remission, and we need to step up treatment to protect your colon and avoid the long-term side effects of repeated steroid use. Steroids are very effective for short-term control, but they are not safe as a long-term strategy because of risks due to:

• Bone density.

• Blood sugar.

• Weight.

• Skin.

• Mood.

• Infection.

Biologic therapies are commonly used in this situation and are specifically designed to control the immune inflammation that drives ulcerative colitis. In women, including those of childbearing age, the anti-tumor necrosis factor agents and several newer biologics have a good long-term safety profile when patients are properly screened and monitored. In fact, maintaining remission with an effective biologic is much safer than remaining on chronic steroids or having ongoing uncontrolled inflammation.

If you are considering pregnancy in the future, most of these medications can be continued under specialist guidance, and having the disease well-controlled before conception is one of the most important factors for a healthy pregnancy.

Regarding colon cancer risk, ulcerative colitis does increase the risk over time, but the level of risk depends mainly on:

• How long has the colon been inflamed?

• How extensive is the disease?

The risk begins to rise after about eight years of disease involving the colon, which is why we start regular surveillance colonoscopies at that point. The most effective way to reduce cancer risk is to achieve and maintain mucosal healing, because chronic active inflammation is the main driver of dysplasia. So moving to a therapy that can control your disease more completely is actually protective in the long term.

The next step is to discuss with your gastroenterologist which biologic or advanced therapy is most appropriate for you, based on:

• The extent of your disease.
• Prior response to medications.
• Personal considerations.

With the right treatment, many patients achieve steroid-free remission, normal inflammatory markers, and a good quality of life.

I hope I have answered your concern. You can consult me at iCliniq for further queries.

Thank you.