Switching from Humira to Remicade

Sorry you’ve been feeling so badly! I remember those days of total exhaustion — both mental and physical!

I’ve never been on remicade or humira so can’t give you any personal experience. I just know others have posted here saying that the 2 are so similar that if one has failed it’s unlikely the other will be successful. That’s not ruling it out because it could certainly happen! (Success with one after failure with the other). You may want to discuss with your dr.

Remicade is more weight based I believe so maybe that will work better for you? Fingers crossed for you! Let us know how you’re doing!

Did the doctors establish why humira wasn't working? i.e. did they test your blood levels of the medication and check for antibodies? If you had low therapeutic levels and/or antibodies to humira then a switch to remicade might work.

One of my sisters recently switched from humira to remicade after developing antibodi8es to humira, however she had a strong response in the beginning which got worse with time, and they knew from the blood tests that her problem was antibodies.

My other sister has maintained a good response to humira by upping her injections from once every 2 weeks to once a week.

Me, I was a primary none responder to remicade (i.e. no antibodies and a good therapeutic level in my blood, and we tried doubling the dose from the standard 5mg/kg to 10mg/kg), so I went straight to entyvio next because the odds of humira working when it uses the same mechanism as remicade, were small.

Post Edited (poopydoop) : 9/24/2021 12:22:25 PM (GMT-6)

I’m thinking about going to remicade now myself.
I’ve been on Xeljanz since 7/3 and that’s not working.
Initially it worked ok for about a month, but then, no good.

I was on Humira from 2016 to 2020 and it worked fantastic for me.
I got pneumonia in the spring of 2020 and I went off it to get over the pneumonia. Per doctors direction.

I was in complete remission from my UC at that time, so when I got over the pneumonia I asked my GI if I could just try managing my UC with just diet and exercise. He said ok.

In January of 2021 I was still doing great with my UC.
My GI said let’s check the blood. Even though I felt great, the blood showed high inflammation markers.
He said “this is not good. You need to go back on a maintenance drug for the inflammation in your body.
Even though your UC is doing great, these markers will eventually lead to other health problems.”

So. We started the Humira back up. THEN, I started flaring. I guess because I was off it for 8 months, my body, built up antibodies to it during that time. Not only would my body not accept the Humira again to help with inflammation in my body, I guess it also kicked off a flare for me. (So much fun! Sigh).

We couldn’t figure out why the Humira wasn’t working for me any more. Ran the blood work. And yup. Tons of antibodies to block the Humira.

As far as UC, 2021 has been rotten for me.

As I noted earlier, I’m trying Xeljanz now since 7/3, to get into remission, and it’s just not working.

I’m also allergic to mesalamine.

So, based on what I am reading above. Remicade might not be a good option for me now?

Post Edited (Rusty Barr) : 9/25/2021 5:30:27 AM (GMT-6)

poopydoop said...
Rusty, if you had a 4 year remission on humira but developed antibodies after taking an 8 month break, I would think there's a pretty decent chance remicade will work for you (because you've previously responded well to another tnf-inhibitor).
It's unlikely that humira would trigger a flare - you already had simmering inflammation before you restarted it so it was only a matter of time before you experienced flare symptoms.

Good stuff. Thank you.

damo123 said...
Rusty,

Remicade and Humira use the same mechanism...they are anti-TNF...so if you fail on anti TNF the changes are significantly higher you will fail another....i do not know your history but is there any way to can use Stelara or Vedo instead as these have a different mechnism of action from Remi and Humira.

So. You think that because of my long break off Humira…then my body building up all that antibody resistance to Humira…(blood work of early this summer showing massive Humira antibody count in my blood, so that’s why I stopped)….high chance the remicade would also get blocked?

I was hoping that they are both tnf blockers…but slightly different…that just because I built up antibodies to one, the other might still work. Again, I was on Humira for four years with fantastic results. It didn’t “fail” directly. I caused the fail by going off it for about 8 months, I believe. Then, when I tried to go back on the Humira, then the “not working”.

I don’t know much about Stelara or Vedo. As long as they don’t have mesalamine in them I should be ok trying one of those next. Which is better?

Post Edited (Rusty Barr) : 9/25/2021 8:15:43 AM (GMT-6)

Rusty, see my comment above. My doc said the same thing that damo said -- that failing one anti TNF would make remi unlikely to work but at the time xeljanz was so new I wanted to give remi a chance first before trying something he didn't even have any other patients on. I think I have read of a few others here who have done the same thing -- switched from humira to remicade successfully.

I ready somewhere that if you don't have any response at all to an anti TNF then it's unlikely that any others in the same class will work, but if one worked and then you lost response another one might work.

Hi Rusty, your antibodies are specific to humira...not remicade.. and you developed them after you left an 8 month gap between infusions. So yes I still think you have a good chance of success with remi. And even if you do build antibodies to remi, it could take years to happen.

Yes I think you are right here damo...it was discussed in a previous thread...i think UCyousee was saying his GI had advised him not to try Remi after failing Humira but to go down the Stelara route instead,

Rusty, I would enquire about trying a diff class of biological if the Humira failed for you. You can always go back to Remicade later. It is more efficient to move class than stay in class if something has failed for you. It might mean that you need other cytokines blocked other the tnf.

thank you beave, that's what I was trying to explain (apparently not very well...)

Here's one of many

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4737871/

From your link:

"During the symposia, some experts recommended limiting the practice of switching patients to a second anti-TNF inhibitor when factors other than immunogenicity were the driver for losing response to treatment..."

So, when immunogenicity *is* the driver for losing response to treatment, switching to a second anti-TNF is perfectly reasonable.