Possibly leaving remicade...try entyvio or humira next?

Hi guys. Some know my story. I will have been on remicade for 3 years this February. I have had some bumps but things have been controlled since starting 6 mp last summer. However I have a patch of inflammation at my rectum/sigmoid that won't heal. I have to use cort enemas to keep symptoms at a minimum.

The area goes back and forth from about a 2 inch area of moderate inflammation to a quarter size patch of mild inflammation. 6 weeks ago it was at a 2 inch area of moderate inflammation...today I got a flex and it is about the size of half dollar and mild. I am going to continue with the cort enemas every other night for a while in hopes that it keeps getting smaller.

Anyway, I am 24 weeks pregnant but this area has been the same for the last 2 years...so I can't make any changes until after my baby girl arrives. I spoke with my GI after my flex today and we both feel that I need to stop the cort enemas as soon as the pregnancy ends (plus I will be having a non-UC related c section and will have trouble doing them in the hospital and then at home for a bit).

We decided to do one more infusion post partum and let my body settle and then switch my biologic. Humira and Entyvio are on the table. My GI said I can try Humira but would suggest switching classes all together and go to Entyvio. I am also seeing a second GI at UPenn for a second opinion.

I'm scared to death either way but need to get off steroids...I am mesalamine intolerant. I don't consider myself as failing anti-tnfs and wonder if Humira would help that area or is it better just to go to a different class?? This is a big gamble because what if the next med doesn't hold me like remicade does...almost 99% healed with 1% refractory

I'm currently on 10mg/kg of remicade every 6 weeks, no antibodies, high levels, and 50 mg 6mp.

Any input is appreciated.

Hey John. I’m currently on 50 mg 6 mp. Been on it since last summer. My gi doesn’t think upping the dose will do much. I’m on the max for my weight but also when i was first diagnosed i tried 75 mg and it killed my liver.

Hey countess. Yes my second opinion gi is Caroline kerner at penn. I’ve met with her once this summer and see her again next month. I meant to email you her name a couple weeks ago...so sorry I’m a scatter brain when pregnant.

Who do you see there?? I’m hoping someone can help me get this patch under control!

I've been on entyvio since the end of march (6 infusions) and it put me into symptom relief. I occasionally have mild urgency and a 2nd or 3rd loose bms a day and I have an area that shows microscopic active colitis but no visual inflammation.

I never tried remicade but here are 2 advantages to entyvio: its supposed to work only in the gut instead of systemically like remicade(note I say "supposed to" ;-D) and the infusion itself is only 30 minutes!

Thanks for the input guys!!

Casey- were you able to get off the cort enemas??

TotesMagotes said...
Thanks for the input guys!!

Casey- were you able to get off the cort enemas??

Yes, I moved to hydrocortisone suppositories (much easier) for lingering proctitis, but I later cut those back to a couple per week.