Traditionally, immunomodulators (Imuran, 6mp, aza) are tried before biologics (remicade, humira, simponi, or entyvio). Although a lot of gastroenterologists are going straight to biologics.
Immunomodulators intentionally lower your body's white blood cell count. WBC are your immune system's attack dog, directly causing inflammation. The less wbc you have, the less inflammation you have. However, your wbc count cannot get too low, so regular blood testing is required (complete bloodcell count test and Hepatic Function Panel test). It's generally weekly, then biweekly, then monthly, and remains at trimonthly as long as you're on this medication. The medication takes about
two months to work, slow working. These are generic medications in pill form.
Biologics work by interfering with your immune system's abilities to request and initiate an attack that results in inflammation. They're much quicker working medications that do not require frequent bloodwork. They're all brandnamed medications and much more expensive. Patient copay assistance programs by the medication manufacturers help keep your out-of-pocket costs minimal. The medications are given through either IV (remicade or entyvio) or self-injections (humira or simponi).
The side effects of immunomodulators and biologics are very similar. You have an increased risk of infections (uti, bronchitis, sinus) and colds/flus. Serious side effects occur but are extremely rare. There's some good information on the Crohn's and Colitis Foundation of America's website that gets into the odds of side effects, and good risk versus benefits information:
Webcast:
programs.rmei.com/CCFA139VL/presentation/player.htmlTranscript
: http://www.ccfa.org/assets/pdfs/risk-and-benefits-transcript
.pdf