Biologic / immunomodulatory therapy
Medicines that change how the immune system works, used to treat immune, inflammatory or allergic conditions, given by injection or drip and needing careful screening and monitoring.
✓ Medically reviewed by a GMC-registered consultant · last reviewed September 2026 · next review September 2027 · how we review
In short
- These medicines change how the immune system works and are often immunosuppressive, lowering your defences against infection.
- Before starting, you need screening for hidden infections — including tuberculosis, hepatitis B and C, and HIV — and a vaccination review.
- Live vaccines are usually avoided while you are on these medicines; non-live vaccines (and ideally key vaccines beforehand) are still recommended.
- They need ongoing monitoring and a clear plan for what to do if you get an infection or feel unwell — and they manage, rather than cure, the condition.
A plain-English summary. The detail — including risks and recovery — is below.
At a glance
A general guide. Your specialist will give you advice for your situation.
Can substantially reduce symptoms and flares of the underlying condition
Active, untreated infection — including untreated tuberculosis or active hepatitis B — must be addressed first.
After an infusion you are observed for a period for reactions. After a home injection, watch the site and how you feel, and report problems.
A named specialist contact and a written plan for infections, surgery and vaccination.
After an infusion you are observed for a period for reactions. After a home injection, watch the site and how you...
Some people notice early improvement, but full response often takes longer. Side effects such as injection...
The medicine's effect on your condition becomes clearer. Your specialist reviews whether it is working and adjusts...
Regular blood tests and reviews check for side effects and continued benefit, often every few months.
What is biologic or immunomodulatory therapy?
Biologic and immunomodulatory medicines change the way the immune system works. They are used for a range of immune, inflammatory and allergic conditions — for example severe asthma, eczema, urticaria (hives), some immune deficiencies, autoimmune and inflammatory diseases. In clinical immunology they may also include immunoglobulin replacement for antibody deficiency.
'Biologic' usually means a medicine made from living cells, such as a monoclonal antibody that targets one specific part of the immune system. 'Immunomodulatory' is a broader term for medicines that turn immune activity up or, more often, down. Many of these treatments are immunosuppressive, meaning they lower the body's defences against infection.
They are given by injection under the skin or by infusion (a drip into a vein), often repeatedly over months or years. Some can be given at home after training; others are given in a hospital or day unit.
Because these medicines affect immunity, they need careful screening before starting (including checks for hidden infections such as tuberculosis, hepatitis B and C, and HIV), monitoring during treatment, attention to vaccinations, and clear rules about what to do if you become unwell. They can be very effective, but they are not a cure and carry real, manageable risks that must be weighed for each person.
Types, options & approaches
There may be different ways to do this. The right approach depends on the clinical question and your circumstances.
Subcutaneous injection vs intravenous infusion
| Feature | Injection (under skin) | Infusion (drip) |
|---|---|---|
| Where given | Often at home after training | Hospital or day unit |
| Time taken | Minutes | About 1 to several hours |
| Reaction monitoring | Self-monitor, report problems | Observed during and after |
| Convenience | More flexible | Needs scheduled visits |
The choice depends on the medicine, the condition and your circumstances. Both need the same careful screening before starting and monitoring throughout.
Preparing for your treatment
- Have pre-treatment screening as advised: blood tests, and checks for tuberculosis, hepatitis B and C, and HIV, because these can flare on immunosuppression.
- Review your vaccinations with your specialist — ideally bringing key vaccines (such as flu and pneumococcal) up to date before starting, as response is better beforehand.
- Tell your team about all infections, recent or recurrent, and any history of TB or contact with TB.
- List all your medicines and supplements, as some interact with immune-modifying treatment.
- Discuss pregnancy, breastfeeding or plans for a family, as advice differs by medicine.
- Ask how the medicine is given, how often, and whether you will inject at home.
- Make sure you understand the warning signs of infection and exactly who to contact if you become unwell.
What happens
Before starting, your specialist confirms the diagnosis, checks you meet the criteria for the medicine, and arranges screening blood tests and infection checks (including TB, hepatitis B and C, and HIV). Your vaccination history is reviewed and any needed non-live vaccines are ideally given beforehand.
If the medicine is an infusion, you attend a day unit; a cannula is placed in a vein and the drip runs over the planned time while staff watch for reactions. If it is an injection, you may be trained to give it yourself at home, with advice on storage and sharps disposal.
You are then followed up regularly. This includes monitoring blood tests, reviewing how well the treatment is working and watching for side effects. You are given a clear plan for what to do if you develop an infection, need surgery, or are exposed to chickenpox, shingles or measles, and which vaccines to avoid.
Is this treatment right for me?
A good consultation should explore whether it's the right choice for you now — including reasons to wait or consider something else.
May not be suitable if…
- Active, untreated infection — including untreated tuberculosis or active hepatitis B — must be addressed first.
- Some severe heart failure, certain previous cancers or specific conditions, depending on the exact medicine.
- People who cannot attend monitoring or follow safety advice, where the risks of unmonitored immunosuppression are high.
- Situations where a safer or more appropriate treatment for the condition exists.
Delay or rearrange if…
- You have a current infection or fever until it is treated and resolved.
- Screening for TB, hepatitis B or C, or HIV is incomplete or shows something needing action first.
- You have just had, or are about to have, surgery or a live vaccine.
- You are or may be pregnant and the medicine's safety in pregnancy is uncertain.
- Recommended vaccinations can still be given beforehand for a better response.
Alternatives to discuss
- Conventional (non-biologic) medicines for the underlying condition.
- Optimising existing treatment, lifestyle measures or trigger avoidance where relevant.
- Watchful waiting or step-up treatment if the condition is not yet severe.
- A different biologic or biosimilar if one is unsuitable, ineffective or not tolerated.
- No immunosuppression where the risks outweigh the likely benefit.
Before you decide
Use this as a shared-decision checklist. The aim is not just “can this be done?”, but whether it is right for you, now, with the risks and alternatives clearly understood.
What matters most to me?
Think about symptoms, daily life, work, caring responsibilities, sport, fertility, travel, appearance and anxiety — the right choice depends on your priorities, not just the medical facts.
What are all my options?
Ask about waiting, monitoring, medicines, rehabilitation, a smaller or larger procedure, a different test, NHS referral, or a second opinion where that would help.
What would make me pause?
Active infection, pregnancy, unstable medical problems, smoking, medicines that increase bleeding, poor support at home, or feeling pressured are all reasons to slow down and get tailored advice.
What happens if I do nothing today?
For some problems, waiting is safe; for others, delay can make treatment harder. A good consultation should explain the trade-off in plain English.
Benefits
- Can substantially reduce symptoms and flares of the underlying condition
- Can improve quality of life and daily functioning
- May reduce the need for steroids or other treatments
- Targeted biologics aim at one part of the immune system, which can mean fewer broad effects than older drugs
- Immunoglobulin replacement can markedly reduce infections in antibody deficiency
- Can slow or prevent damage from ongoing inflammation in some conditions
Risks & complications
- Higher risk of infections, including coughs, colds, chest and skin infections
- Injection-site reactions (redness, soreness) or infusion reactions (flushing, itching)
- Headache, tiredness or feeling washed out around treatment
- Need for regular monitoring blood tests
- More serious infections needing antibiotics or hospital treatment
- Reactivation of hidden infections such as tuberculosis or hepatitis B
- Abnormal blood test results (for example liver or blood count changes)
- Allergic or infusion reactions needing the treatment to be slowed or stopped
- Severe allergic reaction (anaphylaxis), particularly with infusions
- Serious or unusual (opportunistic) infections
- Rare effects depending on the specific medicine, such as certain cancers or neurological problems — your specialist will explain those relevant to your drug
The central trade-off is between controlling your condition and lowering your defences against infection. Hidden infections — especially tuberculosis and hepatitis B — can reactivate, which is why screening before starting is essential. Live vaccines are usually unsafe while on treatment. The specific risks (including any rare links to cancer or neurological effects) depend heavily on which medicine you are given, so ask for the risks of your exact drug, how it will be monitored, and exactly what to do if you become unwell.
Published figures to discuss
Infection and adverse-event rates vary widely between individual biologics, between conditions, and with other medicines such as steroids, so a single percentage would mislead. Tuberculosis reactivation risk in particular differs by drug class and is reduced by screening and treating latent infection before starting. Rather than quote invented figures, this guide flags the categories of risk; ask your specialist for the published rates for your exact medicine.
| Figure | Reported range | How to interpret it | Source / confidence |
|---|---|---|---|
| Serious infection on biologic or targeted immunomodulatory therapy | Uncommon but increased compared with no immune-dampening treatment | Risk varies by drug, dose, age, steroid use and comorbidity. | NHS — Biologic and advanced therapies (Guy's and St Thomas')guysandstthomas.nhs.ukSource-linked context |
| Tuberculosis or hepatitis reactivation | Rare after proper screening, but high impact | Screening and treatment of latent infection before therapy are essential safety steps. | NHS — Biologic and advanced therapies (Guy's and St Thomas')guysandstthomas.nhs.ukSource-linked context |
| Infusion or injection reaction | Uncommon to common depending on the medicine | The first doses may need observation; delayed rashes or breathing symptoms should be reported. | Guide sourcesClinical context |
| Live vaccine given during significant immunosuppression | Avoidable high-impact error | Vaccines should be reviewed before starting treatment, with non-live vaccines kept up to date. | Guide sourcesClinical context |
These are literature figures, not a personalised prediction. Your own risks and likely benefits depend on your circumstances, your health, and how your care is carried out and followed up.
What happens afterwards
There is no physical recovery as such. 'Afterwards' means the response over time, ongoing monitoring, and knowing how to stay safe between doses.
- Mild injection-site soreness or redness that settles
- Feeling tired around the time of treatment
- More minor coughs, colds or infections than before
- A gradual rather than instant improvement in your condition
- Regular blood tests becoming part of your routine
Aftercare
- Watch for signs of infection (fever, persistent cough, breathlessness, burning urine, spreading redness) and report them promptly.
- Keep up your monitoring blood tests and clinic reviews.
- Avoid live vaccines unless your specialist confirms otherwise; do have recommended non-live vaccines such as flu.
- Tell any healthcare professional, including dentists and surgeons, that you are on immune-suppressing treatment.
- Seek advice if you are exposed to chickenpox, shingles or measles, especially if not immune.
- Store and dispose of medicines and needles safely if injecting at home.
- Do not stop, delay or change your dose without speaking to your team.
- Pre-treatment screening (TB, hepatitis B and C, HIV) completed
- Vaccinations reviewed and updated before starting where possible
- Full medicine and supplement list shared
- Pregnancy or family plans discussed
- Home injection training and sharps disposal arranged if relevant
- Written 'what to do if unwell' plan and contact number
- Monitoring blood test schedule understood
⚠ Get urgent help if…
- High temperature, shivering or feeling very unwell (possible serious infection)
- A persistent cough, coughing up blood, night sweats or unexplained weight loss (possible TB)
- Breathlessness, chest pain or a fast heartbeat
- Spreading redness, swelling or pus at any site
- Yellowing of the skin or eyes, or dark urine (possible liver or hepatitis problem)
- Signs of a severe allergic reaction during or after treatment: swelling, difficulty breathing, collapse — call 999
- Exposure to, or symptoms of, chickenpox, shingles or measles if you are not immune
Who to contact: your clinician, clinic or test provider first (keep their number to hand). For urgent advice when you can't reach them, call NHS 111. In an emergency, call 999.
General guidance — it doesn't replace the specific advice your specialist gives you.
Results & realistic expectations
A good response means your condition is better controlled — fewer flares, fewer symptoms, and a better quality of life — with side effects kept manageable. For immunoglobulin replacement, success looks like fewer and less severe infections.
These medicines manage rather than cure the underlying condition. Response is judged over weeks to months, not days, and not everyone responds; some people need a different medicine. The benefit must be balanced against infection risk and the specific risks of your drug, and reviewed regularly.
Many people stay on these treatments long term, sometimes for years, with the dose or interval adjusted over time. Some can eventually reduce or stop treatment if their condition is well controlled, while others relapse if it is stopped. Effectiveness can also fade over time, so the plan is reviewed at intervals. Any decision to start, switch or stop should be made with your specialist.
Related tests, treatments or support
These medicines are sometimes combined with other treatments — for example a biologic alongside a conventional immunomodulatory medicine, or with inhalers, creams or other therapies for the underlying condition. Combining treatments can increase both benefit and infection risk, so monitoring matters. Vaccination planning is an important part of overall care.
Follow-up & long-term care
You should have regular specialist follow-up with monitoring blood tests and reviews of how well the treatment is working and whether side effects are appearing. You should have a named contact and a clear plan for infections, surgery and vaccination. Treatment is reviewed at intervals to confirm it is still the right choice.
- Attend regular monitoring blood tests as scheduled
- Keep recommended non-live vaccinations up to date
- Avoid live vaccines unless your specialist advises otherwise
- Renew home medicine supplies and dispose of sharps safely
- Review continued need, dose and interval at regular specialist appointments
- Carry information that you are on immune-suppressing treatment
Repeat, follow-on and what comes next
- Not everyone responds; switching to a different biologic or class is common.
- Doses or intervals are often adjusted over time, and effectiveness can fade.
- Treatment may be paused for infections or surgery and then restarted on advice.
- Some people can eventually reduce or stop treatment, while others relapse and need to resume.
Ask what happens if the result is unclear or needs repeating, and what is included if further tests or follow-up are needed.
What good aftercare looks like
- A named specialist contact and a written plan for infections, surgery and vaccination.
- A clear monitoring schedule for blood tests and reviews of benefit and side effects.
- Prompt advice routes if you become unwell or are exposed to chickenpox, shingles or measles.
- Support and training for home injection, storage and sharps disposal where relevant.
- Regular review of whether the treatment is still working and still the right choice.
What affects the cost
Costs vary a great deal between people and providers, and we don't publish prices. What matters is understanding what drives the cost and making sure your quote is complete. The main things that affect it:
- The specific medicine and whether a biosimilar is available
- Whether it is given by injection at home or by infusion in a day unit
- Pre-treatment screening (TB, hepatitis B and C, HIV) and baseline tests
- Ongoing monitoring blood tests and specialist reviews
- Day-unit or facility fees for infusions
- Training and equipment for home injection, and sharps disposal
- Management of any side effects or infections that arise
- The specialist (immunologist or relevant physician) fee for assessment and oversight
- Cost of the medicine and each dose or infusion
- Pre-treatment screening and baseline tests
- Ongoing monitoring blood tests and review appointments
- Day-unit or facility fees for infusions, including reaction monitoring
- What is covered if treatment must be paused or switched, or a complication occurs
- Cancellation policy
On the NHS? Many biologic and immunomodulatory medicines are NHS-funded but only when strict clinical criteria are met; private access exists, but specialist screening, prescribing and monitoring are essential either way.
You're entitled to your total cost in writing — including reports, follow-up and what happens if the result is inconclusive — before you decide.
Consent traps and marketing red flags
These are not small details. They are often where patients lose choice, time to reflect, or realistic expectations.
Consent traps
- Starting without screening for TB, hepatitis B and C, or HIV.
- Not reviewing and updating vaccinations, or not warning that live vaccines must usually be avoided.
- Underplaying the infection risk or the need for ongoing monitoring.
- Not giving a clear written plan for what to do when unwell or before surgery.
- Not discussing the specific risks of the exact medicine, including any rare cancer or neurological links, or pregnancy advice.
Marketing red flags
- Describing a biologic as a 'cure' or 'miracle' treatment.
- Offering to start treatment without infection screening or specialist monitoring.
- Downplaying the need to avoid live vaccines or to monitor for infection.
- Pressure to start quickly without weighing alternatives or the criteria for the medicine.
Choosing a specialist safely
- Check the specialist is on the GMC Specialist Register for this area.
- Make sure they work at a CQC-registered service, and look for membership of the relevant Royal College or professional body.
- You're entitled to time to consider and to have your questions answered before you agree — the specialist who looks after you should explain it, not a salesperson.
- Be wary of pressure: time-limited offers or deposits taken before you've had time to think are red flags, not bargains.
- You're entitled to your total cost in writing — including any follow-up — before you decide.
Questions to ask your medical professional
Take this to your consultation. A good specialist will welcome every one of these.
- What is the exact medicine, and what are its specific risks for me?
- What screening do I need before starting, and what happens if something is found?
- Which vaccines should I have before starting, and which must I avoid?
- How will the treatment be monitored, and how often?
- What exactly should I do if I get an infection or need an operation?
- How will we know if it is working, and when would we change it?
- What does the advice mean for pregnancy, breastfeeding or family plans?
- Are you on the GMC Specialist Register for this area, and which Royal College or professional body are you a member of?
- Will you be the specialist who carries out my treatment, and who looks after me afterwards?
- What are the risks for someone like me, and how often do your own patients have a problem or need it repeated or redone?
- What does a realistic result look like — and what can this treatment not achieve?
- What are my options, including waiting, doing nothing for now, or choosing a different approach?
- Can I have written information, results and aftercare instructions in a format I can use, including any accessibility or communication support I need?
- What is the total cost in writing, including any follow-ups, and how much time do I have to decide?
Frequently asked questions
Are these medicines available on the NHS?
Why do I need infection screening before starting?
Can I have my normal vaccinations?
Will it cure my condition?
What should I do if I get an infection?
Can I get pregnant or breastfeed on these medicines?
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How we made this page
Medically reviewed by a GMC-registered consultant. Written in plain English, checked against NHS, NICE, GMC and relevant Royal College / specialist-society guidance, and kept under review. No clinic paid to appear on this page, and we publish no pricing. This is general information to help you prepare — it is not a substitute for advice from your own clinician. How we review our guides →
Source hierarchy: UK regulator and NHS/NICE guidance first, then relevant Royal College or specialist-society guidance, then peer-reviewed evidence for procedure-specific figures where available.
Sources & standards: NHS — Biologic and advanced therapies (Guy's and St Thomas') British Society for Rheumatology — biologic safety and vaccination guidance UK Health Security Agency — Immunisation of immunosuppressed individuals (Green Book ch.6) NICE — Biologics and immunomodulators (search across guidance) MHRA Drug Safety Update — live vaccines and immunosuppression caution UK Primary Immunodeficiency Network (UKPIN) — immunoglobulin replacement UKHSA — Shingles immunisation programme: information for healthcare practitioners
Reviews reflect patients' experience of care, not clinical outcomes. For procedure volumes and outcome data see PHIN.
Last medically reviewed 2026-09-21. Spotted something wrong or out of date? Report an error in this guide.
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