Surgery and Biologics

I have 2 thoughts on this.

First on the dosage. In my mind I wouldn't think the double dosage matters. If one dose is what keeps disease at bay for psoriasis but doesn't work for UC/Crohns because symptoms return the double dose is what gets the patient to the same 12 week period. If that makes sense. So in my mind the same timeframe would seem logical from the last dose because you would need a new dose at 12 weeks.

Next I had all 3 of my surgeries while on Simponi and MTX. I was taking Simponi every 4 weeks for the first two(normal dose for UC but double the dose of RA and psoriasis). With the first 2 surgeries they made sure I was just close to my next shot so I had surgery the week before my next shot was due. Then depending on my recovery each time my GI decided when to resume my shots. Each time I had only delayed my next shot by a week or 2. My last surgery I was on double dose so I was taking it every 2 weeks (so double the UC dose, quadruple the RA/Psoriasis dose). I was only 3 weeks out from my last shot at that surgery.

I think you are right that there is no set answer so no doctor wants to go on record stating what to do. My CR surgeon would never answer and always deferred to my GI for when to stop and start.

I was lucky and did not have any infections or complications healing with any of the 3. But I was also strict with certain probiotics up to and after surgery and didn't eat any refined sugar for a certain period after surgery to help healing.

That's a tough one. It really depends on how fast your body clears the biologic from your body once you cease it, and certainly, a higher dosage would take a bit longer to clear than a lower dose would. Some of the medication is used by your body to fight your pouchitis, in your case. The unused portion of the medication is automatically flushed from your bloodstream through natural processes and that varies a little person-to-person (some clearing it faster and others taking longer). I'd say 10-12 weeks is a pretty safe assumption to have your body be totally free of that medication. However, even being 6 weeks without is much better than having surgery the day of you take your biologic. I know less about Stellera but I am sure the same, general blanket statement applies to many. Stellara is a lot newer, so probably a lot less is known about it.

I'm sure you know Keith, but for the benefit of others reading: Generally, you can have any surgery while on a biologic medication or immunosuppressive medication, however, you are certainly at increased risk for an infection due to that immune suppression. So, it makes sense why a surgeon would prefer you not to be on those medications.

Drat, Richard just posted that before I could . "Stelara pharmacokinetics" is what you want to google. Specifically, you'd want to know more about it's elimination.

"Elimination

The mean (±SD) half-life ranged from 14.9 ±4.6 to 45.6 ±80.2 days across all psoriasis studies following subcutaneous administration. In a population pharmacokinetic analysis of ustekinumab, the clearance was 0.19 L/day (95% CI: 0.185, 0.197) with an estimated median terminal half-life of approximately 19 days in patients with Crohn's disease." That's just the half-life, you still have 50% left at that point.

www.rxlist.com/stelara-drug/clinical-pharmacology.htm

Sorry Keith. A friend of mine with RA had her hip surgery while on a biologic-one of the newer ones. No one mentioned for her to stop, as the RA could come roaring back.
I too need hip surgery, and they don't want to do it within 3 months of a silly steroid shot. Darn Pred...
I'd keep trying to clarify before the next dose, so you don't have to wait in pain.

ks1905 said...
The pain has been almost unbearable the last week or so with the cold weather in the Northeast.

Out of curiosity, what northeast state? We had snow over the past weekend here in NH. So, yeah really frigg'n cold, my furnace has been burning some oil...

iPoop said...
Drat, Richard just posted that before I could .

NY'ers fall into two categories, the quick and the dead.

iPoop said...

Good luck w/the hip replacement that completely sucks, uc the gift that keeps on giving; even after surgery. Will think about that when I take my prednisone tomorrow morning...

I'm choosing this surgeon because he specializes in preventing blood clots, according to his bio on his website.

DVTs are something that us IBDer's need to be careful of, with most surgeries.

I'm looking forward to playing golf in the Springtime when the weather is warmer.

"I'm looking forward to playing golf in the Springtime when the weather is warmer."

I'm positive you will be, and with a better and more consistent swing without the hip troubles. Something to look forward to

Katmom said...
Check the options of Anterior and Posterior methods. I may abandon by old, wise, stick by his old method- surgeon for a newer shiny model who has done tons of the anterior approach. Faster healing, less rehab etc. Sorry to turn you back to Ms Google.

They are doing the Posterior approach on me, it is the surgeon's preference but it is recommended for me due to my age because I'll probably need a revision/replacement in 20-30 years and will lessen the risks associated with the revision/replacement.

So the surgeon's PA got back to me today and like what was said above is correct, I do not have to wait any additional time due to the double dosage.

I will have to wait 4-6 weeks after the surgery until my wound heals to restart the Stelara.

Now I need to book my surgery date. Ugh. Not looking forward to it, the worst part is that I won't be able to drive for upto 8 weeks after surgery.

I just booked my surgery this morning, it will be 12 weeks since my last Stelara dosage as they recommended.

My surgery date is December 7th. I will need to stay 3 days and two nights in the hospital, that's what they do for all their joint replacement patients, hopefully mine will be the same but I'm a little worried about my GI tract not waking up from the anesthesia and getting ileus from it which would require a couple of extra days in the hospital.

I've been hearing a lot of positive stories from people about their hip replacements and that they recovered much faster than expected and were living a pain free life.

The whole 8 weeks without being able to drive is going to be brutal.