HealingWell
Search Close Search
☰

Step-up or top-down approach

Support Forums
>
Crohn's Disease
✚ New Topic ✚ Reply
❬ ❬ Previous Thread |Next Thread ❭ ❭
Posted 2/19/2018 1:46 PM (GMT -5)
So after my coloscopy this upcoming friday i think i will finaly get an answer to whether i have chrons or Ulcerative colitis. Im leaning towards chrons since i am going 4:6x a day with only occasional bleeding. Besides the abdominal pain and urgent BMs i feel decent. I have quit smoking a couple moths ago and i deff think it was keeping my symptoms in check.

Annway has anyone heard of the top down approach. I am thinking about telling my GI to skip all of the oral medications and what not and hit the disease hard while it is mild. I have heard ramicade early on in the diseases natural course can be promising and read a journal recently that said some doctors are switching up the old methods of the step up approach.

What do yoh think? Pros and cons?

If i go with the hard stuff first and it fails will i be left optionless?

Thank you for reading and replying, good luck and good health

Post Edited (albear99) : 2/19/2018 4:02:25 PM (GMT-7)

Posted 2/19/2018 2:18 PM (GMT -5)
There are new medications coming out all the time I don’t think you will ever be optionless but in my opinion I would start with the small stuff first and not skip straight to a biologic. But then again that’s what I did and I had to have surgery but it is different for everyone! But I have heard about remicaide early in treatment being beneficial. I would see what your GI has to say and be open minded.
Posted 2/19/2018 2:50 PM (GMT -5)
This GI is pretty by the book so i think he will go with the small stuff first. However a friend of mine with chrons said ramicade saved his life , as well as larry nance jr. I think im personally going to ask him to start there. I dont want to experiment with this or that and still be suffering. Thank you, i know everyone is different. 7 years old, man you a warrior. I just turned 24!
Posted 2/19/2018 2:57 PM (GMT -5)
Yea I had a friend from high school who started remicaide first and she’s been basically 100% ever since! —and my friends dads friend has been on remi for 10 years with no issues. Yea I had it for a long time I am 20 now! Hopefully your gi listens to your opinion, if not you could always find another one! smile
Posted 2/19/2018 5:29 PM (GMT -5)
None of the biologic drugs are available as a generic version, so they are all very expensive, ranging from $2,099 per month to more than $5,000 per month. I hope you have good insurance. Besides insurance, another question to ask your doctor is that once you start a biologic, is it best practices to remain on a biologic permanently or at least until surgery is needed?

I will never advise avoiding biologics if that is the only way to get your inflammation under control. But why not try something with fewer side effects first?

You are a young man at 24 years old. How do you know that you may or may not need to take another immunesuppressive med along with the Remicade? Another ”black box” was issued in 2008 describing cancer occurring in children and young adults who began taking TNF blockers, such as Remicade, Humira, and Cimzia, along with immunesuppressive medicines such as 6-MP.

While previous studies indicated the increased risk of infection and lymphoma, evidence published in 2006 in the Journal of the American Medical Association suggested that Remicade can triple the risk of skin cancer.

Your doctor may prescribe mesalamines which OTOH are known to help prevent cancer.
Posted 2/19/2018 5:37 PM (GMT -5)
My Nurse explained it this way, seems like the "older" doctors were brought up using the "bottom up" approach. Use the weakest, safest drugs first then if that does not work go to the next stronger until you find something that works. The "younger" doctors have been taught to go straight to the strong stuff. Their theory being why waste months if not a year or two seeing if the weaker stuff works mean while the patient may be getting worse and worse. My doctor started with Humira, that did not work so am on Remicade and just had a colonoscopy that show no inflammation! So for me the top down approach was the right way to go.
Posted 2/19/2018 5:47 PM (GMT -5)
There are also many others who are on milder meds who show little or no inflammation.
Posted 2/19/2018 6:16 PM (GMT -5)
This is what i read

Pros: The use of immunosuppressants and biologicals especially in patients with CD has decreased the rates of surgery and hospitalizations, indicating that there is a group of patients definitely profiting from such an early use of immunosuppressive treatment.

Cons: risk of infection

I havnt read anything about ramicade increasing the risk of cancer, any sources you can provide? Risk of infection is basically a side effect of most of these medications unfortunately, the people i have personally heard from have no side effects at all from remicade

I do have medical insurance, so i think i would have to pay maybe a few grand for the entire year before i reach my deductible and receive full coverage.

Post Edited (albear99) : 2/19/2018 4:19:38 PM (GMT-7)

Posted 2/19/2018 8:36 PM (GMT -5)
The side effects of cancer are also extremely rare, although they do happen... I know there’s an increased risk for lymphoma and certain other cancers with humira but I’m not sure about any of the other biologics, when I was in humira I never got an infection once so I feel like the risk for infection is also low, but a lot higher than people with normal immune systems. And it also depends if you take aza or soemthing like that along with it.
Posted 2/20/2018 8:56 AM (GMT -5)
I think you need to wait to see what your doc recommends. You insurance company might insist that you start with immune-suppressives like 6MP or Methotrexate first before approving biologics. It isn't an issue of older and younger doctors as much as some of the logic is that if you are young like you are at age 24, then you have to live with the disease for a longer time in your lifetime. They tend to be more aggressive with younger patients for that reason. Some people have mild Crohn's that remains mild, and never need biologics. I know it's hard, but try to wait for your appointment and hear what your doc has to say. You can get a second opinion as well.
✚ New Topic ✚ Reply