Is biologic therapy safe to manage my ulcerative colitis?

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I understand the concern.

The current symptoms, along with colonoscopy findings showing moderate continuous inflammation in the left colon, indicate that ulcerative colitis remains active despite treatment with Mesalamine. The need for repeated courses of corticosteroids suggests that the disease is not adequately controlled with the present regimen.

In such cases, escalation of treatment to the biologic category of drugs is the right thing to do. Drugs like Infliximab and Adalimumab fall into the category of anti-Tumor Necrosis Factor agents. These drugs work on the tumor necrosis factor, which is one of the most important inflammatory mediators in the development of ulcerative colitis. The main objective of this drug class is to attain sustained remission, mucosal healing, and reduction in corticosteroid dependency.

Biologics have been in use for several years now and have an acceptable safety record, provided that the right screening and monitoring are done. Infection screening for tuberculosis and hepatitis B infection should be carried out before the initiation of these drugs. Regular testing will greatly minimize the chances of adverse effects. Although the use of these drugs results in a slight increase in infection risk, this can be minimized through proper monitoring.

In terms of future pregnancy, biological medications such as anti-tumor necrosis factor agents, including Infliximab and Adalimumab, have been researched extensively in reproductive-age women. Presently, it is believed that such medications can be used during pregnancy, where necessary.

The most important factor for a healthy pregnancy outcome is maintaining disease remission at conception and throughout pregnancy. Active ulcerative colitis poses a greater risk to both mother and baby than the biologic medication itself. Treatment plans during pregnancy are individualized, and coordination between a gastroenterologist and obstetrician is recommended.

The adverse effects seen with the use of corticosteroids include weight gain and acne, among others, which demonstrate why steroid therapy is always used for short durations when possible. Such steroids as Prednisolone are quite useful for short-term use and treatment, but not for maintenance because of their metabolic, osteological, and hormonal adverse effects. Biologics are good for managing the inflammation without any long-term risks that can appear due to repeated steroid therapy.

Regarding the development of colon cancer, there is an increased risk of the development of the condition in people with longstanding ulcerative colitis. This is due to the fact that long-lasting and severe inflammation in the colon increases the chances of developing this kind of cancer. Controlling and managing inflammation and achieving and maintaining mucosal healing significantly reduce the risk of colon cancer. Surveillance colonoscopy is needed, starting at about eight years since the diagnosis was made.

The disease pattern described is consistent with moderate left-sided ulcerative colitis that is steroid-dependent. Transitioning to biologic therapy such as Infliximab or Adalimumab is a medically appropriate next step. With proper monitoring, these treatments are considered safe for long-term use, are generally compatible with future pregnancy, and, by effectively controlling inflammation, they help reduce long-term complications, including colon cancer risk.

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Thank you.