I have ulcerative colitis. Are biologics safe long-term?

Question

Hello doctor,

I am 32 and have been living with ulcerative colitis since college. Recently, the colonoscopy report showed moderate active disease even though my symptoms were mild. The doctor suggested starting Humira injections.

I am confused because injections sound like a strong treatment. So, my concerns are:

Are biologic medicines usually started when tablets stop working?
Also, how safe are these injections in the long term, especially regarding infections or other complications?
My CRP was slightly elevated, and fecal calprotectin was around 420. Does that mean the disease is currently more active?

Kindly suggest.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

Your colonoscopy and tests suggest active ulcerative colitis, even if symptoms feel mild. This situation is not uncommon. Tests such as fecal calprotectin and C-reactive protein (CRP) help measure inflammation in the colon.

A calprotectin level around 420 usually indicates ongoing intestinal inflammation, meaning the disease is still active despite relatively mild symptoms.

Because of this, your doctor recommended Adalimumab (Humira), a biologic therapy. These medications target specific inflammatory pathways in the immune system, particularly the molecule TNF-alpha (tumor necrosis factor), which plays a major role in ulcerative colitis inflammation.

Biologics are often considered when standard medicines like Mesalamine or steroids do not fully control disease activity, or when tests show persistent inflammation.

Although injections may sound like a strong treatment, they are commonly used today and can be very effective in inducing and maintaining remission and preventing long-term colon damage.

Regarding safety, biologics are generally well-tolerated with proper monitoring. Because they suppress part of the immune system, there is a slightly increased risk of infections, so doctors usually screen for tuberculosis and hepatitis before starting therapy.

Regular follow-up and blood tests help ensure safety. Most patients can use these medications for many years with good outcomes. The goal of treatment is not only symptom relief but also healing of the intestinal lining, sometimes called “mucosal healing.”

Starting biologic therapy when inflammation persists can reduce future flares, complications, and the need for steroids.

Discuss any concerns with your gastroenterologist, but many patients with ulcerative colitis achieve long-term disease control and improved quality of life with biologic therapy.

I hope this helps.

Thank you.