Infusion Therapy for Ulcerative Colitis

Medically Reviewed by Melinda Ratini, MS, DO on March 24, 2025
Written by Marijke Vroomen Durning, RN
9 min read

If your doctor has recommended infusion therapy, this is probably because standard treatment hasn’t helped relieve symptoms caused by moderate-to-severe ulcerative colitis. You most likely have been taking medications by mouth, orally. Infusions are medications delivered to your body by intravenous (IV), directly into your bloodstream, sometimes with an option to go to injectables over time. Sometimes, infusion therapy is used as a first-line therapy for moderate-to-severe cases. 

“I think a lot of patients have an idea that IV infusions are stronger or more powerful [than the other medications],” says Raymond Cross, MD, medical director at the Center for Inflammatory Bowel and Colorectal Diseases at Mercy Medical Center in Baltimore, Maryland. “In fact, that’s not the case. It’s just the way the drug is delivered.”

IV infusions for ulcerative colitis have been helping many people improve their quality of life.

The different medications that can be given as infusion therapy for ulcerative colitis treat the disease in different ways. These medications may:

  • Target specific substances that cause inflammation
  • Focus on the gastrointestinal inflammation rather than your whole body
  • Cause fewer side effects because only part of the immune system is targeted
  • Are given in fewer doses, spread further apart
  • Reduce the need for corticosteroids
  • Improve quality of life by managing symptoms

The type of medications used for infusions for ulcerative colitis depend on many things, including how the medication works, how you respond to them, and recommended use. These are just a few of the treatments used:

Infliximab (Remicade) for ulcerative colitis

Infliximab has several brand names but is most commonly known as Remicade. It’s one of the most well-known biologics used to treat ulcerative colitis. Infliximab is in a category called anti-tumor necrosis factor (anti-TNF), and it helps reduce the inflammation in the bowels.

Remicade infusions for ulcerative colitis have a good response rate. Between 67% and 78% of people receiving it have seen improvement in their symptoms. 

Side effects. It may seem like infusion therapy for ulcerative colitis causes many side effects, but all medications have them and not everyone experiences them. In general, doctors find that infliximab is well tolerated by patients, which means side effects aren’t that common, although they might increase as people reach age 60 and older. 

The most common side effects include:

  • Abdominal pain
  • Diarrhea
  • Headache 
  • Infections
  • Nausea
  • Reactions while getting the infusion

Some other, less common ones are:

Some people might not be able to take infliximab because of other health problems. They include people with:

  • An active infection
  • Heart failure
  • Previous allergic reactions to the drug
  • Sepsis 

Vedolizumab (Entyvio) for ulcerative colitis

Vedolizumab works a different way than infliximab to treat ulcerative colitis. It inhibits (blocks) certain cells that cause inflammation, called integrin receptor antagonists.

The response rate for vedolizumab in treating ulcerative colitis is lower than infliximab, but it’s still effective for almost half of people who use it.

Side effects. When discussing side effects of vedolizumab and others in this category, Cross focuses more on the chances of getting an infection over the possible reported side effects, like headache. “I tell them you have about a 1% risk a year of a serious infection,” he says. “That’s typically an infection that requires hospitalization with some sort of [antibiotic]. It’s probably even less than that in real life once they’re off steroids, but it’s what I mention.”

Reported side effects affect 10% or less of patients and include:

  • Back pain
  • Cough
  • Fatigue
  • Headache
  • Increased risk of infections
  • Itchiness
  • Nausea
  • Skin rash
  • Sore joints
  • Sore throat
  • Upper respiratory tract infections, including colds and influenza
  • Vomiting

There aren’t many people who shouldn’t take this drug, although you shouldn’t take it if you have an active infection. People who are breastfeeding should discuss this with their doctor to see what the best approach is.

Natalizumab (Tysabri) for ulcerative colitis

Natalizumab is an immunomodulator, which means it stimulates or suppresses your immune system to help fight certain diseases. According to Cross, this drug isn’t used often anymore. “It was the first non-anti-TNF that we had,” he explains. “It’s rarely used anymore because it’s associated with a very rare risk of PML [progressive multifocal leukoencephalopathy], which can cause a fatal reactivation of a virus that causes a neurological syndrome in the brain.” That said, the drug is still available because it can be helpful for the right patient.

Side effects. Natalizumab causes side effects in 10% or less of those who take the drug. They include:

  • Constipation
  • Cough
  • Dermatitis
  • Diarrhea
  • Fatigue
  • Indigestion
  • Night sweats
  • Painful menstrual cycles, irregular periods, lack of periods
  • Sinusitis
  • Skin rash
  • Sore joints
  • Sore teeth
  • Sore throat
  • Swelling in the arms and legs
  • Tremors
  • Urinary tract infections
  • Urinary urgency, frequency, incontinence
  • Vaginal infections
  • Vertigo
  • Viral infections

People who might not be able to take this drug include those who have:

  • Herpes infection
  • Liver disease

Ustekinumab (Stelara) for ulcerative colitis

Ustekinumab blocks proteins called interleukin-12 (IL-12) and interleukin-23 (IL-23), which increase inflammation in your body. It has lower response rates, but it also has a lower rate of side effects. According to research, this medication helps over 40% of people who take it every eight weeks.

Side effects. Side effects for ustekinumab include:

  • Back pain
  • Cellulitis
  • Depression
  • Diarrhea
  • Fatigue
  • Headache
  • Itchiness, skin rash
  • Nasal congestion
  • Redness around the injection site
  • Sore muscles or joints
  • Sore throat
  • Upper respiratory infections

People who shouldn’t take ustekinumab include those who have an active infection or tuberculosis (TB). It should be used in caution in people who:

  • Are older than 60
  • Have chronic or recurrent infections
  • Have a history of cancer
  • Are on treatment that suppresses their immune system
  • Are taking allergy immunotherapy
  • Are having photochemotherapy (PUVA)

People who use the prefilled syringes cannot be allergic to latex. 

IV steroids for ulcerative colitis

IV steroids for ulcerative colitis isn’t a long-term treatment. “When a patient has severe ulcerative colitis and they're admitted to the hospital, standard of care is typically going to be three days of intravenous steroids,” Cross explains. “If patients respond, then they get transitioned to oral prednisone and then they're tapered slowly as an outpatient, but then they need to be bridged to one of these advanced therapies.” 

According to Cross, about 15% to 25% of patients will be admitted to the hospital during their lifetime for a flare that requires treatment. “Maybe that's a little less these days because we have so many good therapies, but we still see these patients.”

The exact process of the infusion procedure may vary between clinics and hospitals, but the basics are the same. Before you go for your first infusion, check to see  what you should bring with you. You might want to bring a light blanket or jacket to cover yourself because some infusion rooms are quite cool. Be sure to wear comfortable clothing with sleeves that allow the nurse to access your arm easily. If a friend or family member wants to keep you company, check to see if that’s OK.

When you arrive, a nurse will speak to you about how you’re feeling and check your vital signs to be sure you don’t have an infection or other illness that could affect your treatment. This is also your opportunity to ask any questions you might have. Once the nurse determines that it’s fine to go ahead with the treatment, you’ll be guided to the infusion area if you’re not already there. Usually, infusion rooms are set up with big armchairs, but there might be some beds as well. 

When you’re comfortable, the treatment nurse will then start an IV. If blood tests are ordered, the nurse will take some blood samples and then start the infusion. This can take anywhere from 30 minutes to an hour or two, depending on the medication and your IV. Sometimes, IVs run slower than they should.

During the infusion, you’ll be checked regularly, especially at the beginning, to make sure you don’t have a reaction to the medication. You can read or use your electronic devices to keep busy during the infusion. Unless there is a reason why you can’t, you should be able to get up and walk around, with the IV pole, to go to the bathroom, or just move around.

Once the infusion is finished, if there are no reactions to the medications and you feel fine, you are free to go home.

Whether ulcerative colitis infusion therapy is right for you is a question that only you and your doctor can answer. If you’re hesitant, speak to your doctor about your concerns. “I just try to remind [patients] of the dangers of a relapse,” Cross says. “A relapse can be so severe that we may not get it under control, that may require surgery or permanent stoma.”

If your disease is mild to moderate, infusion therapy isn’t typically recommended, and about 50% of patients who have more advanced disease respond well to the entry-level drugs, according to Cross. “But anyone who is progressing beyond that is a candidate for advanced therapy, which includes biologics,” he explains. There are some patients who have other medical conditions that might rule out some ulcerative colitis therapies, but Cross says that they can almost always find an appropriate and safe treatment. 

Infusion for ulcerative colitis is treatment that is given by IV and sometimes later by injection. These infusions are usually reserved for people who don’t get help from the standard treatments, about half of those with moderate-to-severe disease. The medications work well and can reduce the number of flares, reducing how often you would need to take steroids or be hospitalized.

How often will I need infusion for ulcerative colitis?

An infusion schedule  will depend on several factors including which medication you are on and how you are responding to the treatment.

Will infusion put ulcerative colitis into remission?

Medications given by infusion to treat ulcerative colitis do put many people into remission from the disease. How effective they are depends on the type of medication and how your body reacts to it.

Does insurance cover infusion for ulcerative colitis?

It’s important to learn if your insurance covers the medications used for ulcerative colitis infusions before you have your first treatment. Most do cover infusion therapy but not all at the same levels. Contact your insurance company for information on coverage and your copay.

What is the cost of ulcerative colitis infusion?

The cost of medications for ulcerative colitis varies across the country and depends on the medication itself, if your insurance covers it, and how much your copay might be. Discuss the cost with your insurance company and your hospital or doctor’s office to learn what the cost will be for you. If you are uninsured or underinsured, check out the Patient Financial Assistance Programs at the Crohn’s & Colitis Foundation website. They have a tool that can help you find if there are programs that you might qualify for.