Biologic Infusions: How to Prepare, What to Expect, and More

Chronic autoimmune diseases can be difficult to manage and can cause significant problems for people who have them. Biologic infusions are a relatively new way to treat these conditions. These infusions are typically well-tolerated, but they have some unique features, including the way they are given.

Below, we will discuss what you should expect when you receive a biologic infusion, and why these medications may be a good option for you.

What are biologic infusions?

Biologic infusions are usually given to you at a hospital or healthcare facility, but they can sometimes be given at home. They are liquid medications that are administered to you through an intravenous (IV) needle in one of the veins in your arm. They are not given all at once — instead, they are delivered slowly over a certain period of time. This process is called infusion.

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These medications are created using advanced technology. They are called “biologics” because they can be made from living cells, as well as proteins, sugars, and DNA. The word “biologics” refers to many medications and even includes commonly prescribed products like insulin.

Many biologics are used to stop your body’s immune response. We want to stop this process when it is hurting you, like in the case of autoimmune disorders where your immune system is attacking your own body. Using this type of biologic, we can stop and prevent the damage from these conditions.

Which conditions can biologic infusions help treat?

Biologic infusions can be used for several illnesses, but we’ll focus on the autoimmune diseases these infusions can treat. Some of these include:

• Rheumatoid arthritis

• Psoriasis

• Psoriatic arthritis

• Ankylosing spondylitis

• Crohn’s disease

• Ulcerative colitis

• Multiple sclerosis

• Lupus

What are the benefits of biologic infusions over injections?

Biologic medications are frequently used to treat autoimmune disorders because they are effective and the side effects are manageable for most people. Your provider will typically prescribe them for you if other medications used to treat your condition aren’t working as well on their own.

Some of these medications are only available as a subcutaneous (SC) injection or intravenous (IV) infusion, while others are available as both. There are pros and cons to both of these routes, and which one you’re prescribed typically depends on preference and insurance coverage.

Injections can be done at home, where you’ll need to inject the medicine into the “subcutaneous” tissue just below your skin — most commonly in the stomach, upper arm, or thigh. They don’t work as long as infusions, so you’ll need to administer them more often. If you have a hard time giving yourself shots, then infusions may be a better option for you.

With infusions, you’ll most likely need to travel for your treatment, and they take longer than giving yourself shots at home. However, you’ll only need to get them done every 1 to 2 months or so, depending on your medication. And if you frequently travel for work or vacation, you won’t have to worry about bringing your medication with you.

Which medications are available by infusion?

There are many biologic medications available by infusion, and we expect more to be developed and FDA-approved in the coming years. The three we’ll discuss below are:

• Remicade — used for rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, Crohn’s disease, plaque psoriasis, and ulcerative colitis

• Entyvio — used to treat ulcerative colitis and Crohn’s disease

• Tysabri — used to treat multiple sclerosis and Crohn’s disease

How should I prepare for my first biologic infusion appointment?

If you will be going to an infusion center, your appointment is likely going to be different than those you’ve been to in the past. When you arrive, a nurse will place an IV needle connected to a thin tube into your vein. When the IV is successfully placed, your nurse will start the infusion, and the medication will move through the thin tube and into your vein.

It’s best to drink lots of water before your appointment, as this can make it easier for your nurse to insert the needle. Wearing loose and comfortable clothes with easy access to your arms also makes infusion set-up a smoother process.

It’s very important to make sure you’re not feeling sick when you show up to your appointment. This is both to prevent exposing others at the infusion center to infections and to protect yourself. Most biologic medications weaken your immune system, and if you have an infection brewing, your infusion could make it worse.

What should I expect during a biologic infusion?

Biologic infusion times vary, but you will likely be sitting for at least 30 minutes. So you’ll want to bring something to help pass the time like a book or magazine. Make sure your electronics are charged, and bring headphones if you are going to listen to anything on your device during your infusion.

Remicade infusions

Remicade infusions last 2 hours. At the start, your temperature, blood pressure, and heart rate will be checked. A healthcare professional will check on you at least once during the infusion. You may be asked to stay at the infusion center afterwards to make sure you are not having an allergic reaction.

Entyvio infusions

Each Entyvio infusion lasts about 30 minutes. A healthcare provider will watch you for side effects and allergic reactions both during and after the infusion. Receiving this medication at home instead of an infusion center may be an option with Entyvio, so ask your provider for more details if you are interested.

Tysabri infusions

You can expect your Tysabri infusion appointment to last 2 hours — 1 hour for the actual infusion and 1 hour after the infusion for monitoring. Because of the risks this medication has, there are extra steps involved for a provider to give you Tysabri. They must be certified by the Touch® program, and they have to complete a special online form before each dose.

What do I need to know after I’ve gotten an infusion?

After your first infusion, your healthcare provider will likely want to watch you for a certain period of time —  usually between 15 to 60 minutes — for any signs of an allergic reaction (e.g., swollen lips, shortness of breath, rashes). You should also be provided with information about who to call if you are having any problems after leaving the infusion center.

Headaches are common after an infusion. They are typically caused by changes in the amount of fluid in your body. These are temporary and should go away within 24 hours.

Your risk of infection is higher after getting any kind of infusion that weakens your immune system. You should have a plan with your provider about who to call if you develop a fever or other symptoms of an infection. Each biologic infusion is different, and they all have their own unique side effects. Discuss these with your provider before your first infusion, so you know what to expect. 

Lastly, it takes weeks to months to see improvement in your condition. It is unusual for symptoms to get better right away. Talk to your provider about how to best manage your symptoms until your infusion starts providing relief.

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Written by:

Meg Burke, MD

Meg Burke, MD, is a practicing primary care geriatrician in the Denver, Colorado area. She is board-certified in internal medicine and geriatric medicine, and received her undergraduate and medical degrees from Georgetown University in Washington, D.C. After graduating from medical school, Dr. Burke completed her internal medicine residency at Johns Hopkins Bayview Medical Center and her two years of subspecialty training in geriatric medicine at the Johns Hopkins Hospital in Baltimore, Maryland.

Edited by:

Sophie Vergnaud, MD

Sophie Vergnaud, MD, is the Senior Medical Director for GoodRx Health. An experienced and dedicated pulmonologist and hospitalist, she spent a decade practicing and teaching clinical medicine at academic hospitals throughout London before transitioning to a career in health education and health technology.

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