Making the jump to Humira -should I try anything else before I take the plunge?

So here I am on my 4th week of 40mg Prednisone and Symax Duotab. In the last week I've seen incredible symptom improvement -have gone from urgent, uncontrollable diarrhea once every three hours to one non-urgent (but still a little bit crampy) bowel movement every 8-12 hours. Still having a mix of semi-formed stools about 50% of the time and mush the other 50%. No blood in two weeks. Symptoms appear to be improving daily.

Obviously I cannot stay on 40mg of Pred forever. Doc wants to start me on Humira right away.

What I want to know is, before I take the plunge, should I push to try something else that isn't such a heavy drug? I know I need a maintainance drug. Asacol and Lialda both made me worse, so that isn't an option.

I'm concerned for two main things with the Humira:

1. The possible side effects like cancer, etc.

And 2. The possibility that if I have a serious flare in the future, I will have already used my 'magic bullet.' I've heard that Humira can become less effective with subsequent flares?

Am I wrong in thinking that now that this flare is finally coming under control with Prednisone, Humira may be overkill?

Any suggestions? Input? Anything else I can try?

I wouldn't worry about losing that as an option, what else are the options right now? You could try 6mp/imuran, but they take longer to work, other biologics, but it's the same situation. The reason I say I wouldn't worry about losing the option is because, in my case, I held on to it and I was a non-responder. Not everyone has it as an option in the first place (I think Remicade has the highest likelihood of response and that's a little over 60% - 40% do not respond). I thought I had the magic bullet in my back pocket, then no response...

The fact is that, we all get complacent when we are feeling better, even if we are on prednisone, and we think "hmm, maybe I should try to taper off, maybe I don't need to add anything, or maybe I just need a little something, nothing major...". The reality is, 4 weeks on 40mg to get to so-so, is pretty severe in my opinion. I would do what the GI suggests. As I said though, I did what the GI said and it still didn't work, so being the perfect patient doesn't always end up working out regardless. I am sure you will do great on Humira, or whatever you choose. The cancer stats are very, very low. You should look it up. It will put your mind at ease. Of course it is increased, even if it's just 1%, it's something to consider.

I went on Humira earlier this year and I'm currently on Remicade (currently in the loading phase).

I believe the Remicade is helping me, while the Humira did absolutely nothing for me. To be honest, I kinda wish I had started out on Remicade first because I feel like the time I spent waiting to see a response from Humira was just wasted. Humira takes a longer time to kick in compared to Remicade and also has a lower response rate for UC patients. I suppose it is a little more convenient than Remicade since you administer it yourself and the injections are quick to do. Of course, it would be great Humira works for you.

Entyvio is also an option and works a little differently than Humira and Remicade. I believe the issue of antibody development is less prevalent with Entyvio as well. Pretty sure Entyvio has a little bit better response rate than Humira, but not quite as good as Remicade.

Immunosuppressants are an option too, but increases the risk of T-cell Lymphoma (which occurs almost exclusively in young males). My doctor thought the risk of something like 6MP outweighed the potential reward since I fit into the young male demographic.

If you haven't tried it already, you could always try some sort of diet modification if you're patient and willing to adhere to a strict diet e.g. AIP Paleo, SCD, etc.

Canaveral said...
What I want to know is, before I take the plunge, should I push to try something else that isn't such a heavy drug? Any suggestions? Input? Anything else I can try?

You can always taper down prednisone and then see what happens if you're so unsure. When I was prednisone dependent at 20 mgs, had a scope with severe inflammation then the choice was pretty obvious. I added remicade and I had a good 2.5 year remission and am now going through a minor flare after eliminating too many medications (everything but Remicade).

Immunomodulators (imuran/azathioprine, or 6mp) are another choice, often tried before biologics. They take 2-3 months to work though, with prednisone as a bridge until they do. They also increase cancer odds, like biologics do. Immunomodulators and biologics actually very similar risk vs benefit profiles.

There's many alternatives to try, a lot of time in trialing each and waiting for results. A lot of things won't work for uc, only a few actually do.

I guess my doctor's main concern right now is keeping me on the 40mg Pred too long. He says since I'm so young and slight of frame I'm at increased risk for developing osteoporosis and all the other nasty things it can cause. I think that's why he wants to try Humira first, since it works quicker.

Thanks for calming my fears about Humira guys. My Mom is scaring me to death because she has Rheumatoid Arthritis and is talking about all these people in her Rheumatoid forums who have supposedly suffered dire consequences from Humira. She's definitely in protective Mom-mode right now. TBH though, I wonder if that might be due more to the nature of that specific disease and the combination of meds that they take for it.

One factor that's usually overlooked when evaluating the increased cancer risk with Humira, which I think is so small that it's negligible, is the much greater risk of colorectal cancer once you've had UC for 10 or more years:

www.ccfa.org/resources/risk-of-colorectal-cancer.html

It's the chronic inflammation that drives up the cancer risk. If Humira is effective in reducing the inflammation it should reduce the colorectal cancer risk as well.

Keep in mind that the population with rheumatoid arthritis is that it's heavily skewed towards the elderly. They're going to have all sorts of health issues arising that probably have nothing to do with Humira.

One thing that made me feel good about Humira is that it's not a systemic drug in the traditional sense. It's very narrowly targeted to attach to and deactivate one molecule your immune system produces, which should make it safer than a drug that has a broader range of effects on the body.

I am really, really glad I started Humira a month ago. The worst thing I've experienced was a mild headache for about half a day after the initial four injection loading dose. Other than that it's been nothing but benefits.

Post Edited (Richard in NY) : 10/18/2016 8:55:55 AM (GMT-6)