Remicade a bridge for Entyvio?

I haven't heard of anyone doing this. Three entyvio infusions will put you at how many weeks? My GI said if you don't have a response in 10 weeks, the chances of responding are low. If you're getting close to that mark, of course ask your GI, but it may be worth discontinuing entyvio and starting something else. I understand your cancer situation, and the other drugs may be more risky, but there's no reason to continue entyvio if you're not responding to it. Have you had stool tests? What dose of prednisone are you on? Are you using any other medications? They could do cyclosporine as a bridge, that would likely make more sense, but again, no guarantee it will give you a response that lasts beyond the treatment.

I've never heard of using two biologics simultaneously.

1.) What's your current prednisone dosage?

2.) Had you considered adding in oral and rectal-route mesalamines (lialda/apriso/delzicol and rowasa)?

3.) Have you considered adding an immunomodulator as a bridge (methotrexate is fast working)? Or are they a no, no due to the past cancer issue? I know 6mp/imuran sometimes isn't recommended for those who've had skin cancer in the past (some have had melanoma relapses due to 6mp/imuran). Not sure if that applies to methotrexate as well. Methotrexate isn't as common as 6mp/imuran for UC patients though!

JGS 75 said...
If by some chance the insurance were to approve it, what kind of havoc would having two biologics in your system at the same time cause?

I don't believe it has been studied. The goal of biologics is to slightly reduce the immune system's ability to request, initiate, and complete an attack. Remicade mutes the request/signal for an attack, and entyvio limits the completion of the attack. You'd just want to make sure you aren't suppressing the immune system too much with dual biologics (I don't know if it would, but that would be the primary concern). As you still have infections, colds, flus, and other things to contend with in our everyday lives.

4.) Your doctor can submit a request to your insurance to see what happens, your situation is unique with the limitations of a prior cancer so maybe it would be considered differently perhaps? I would expect an initial denial. He can appeal and sometimes they are approved.

5.) Has your doctor done remicade as a bridge to entyvio before? What was the results? How many patients? I would ask questions like that. And I'm curious about those answers too!

Thanks for the input. I will definitely bring these up these questions with my GI at my appt next week.

On another note, I’ve had four days in a row now with significantly reduced symptoms. Somewhat solid stool, 2 BM’s a day. So either the prednisone is finally doing something (besides making my hands shake and make me want to yell at my kids) or even better the Entyvio might be kicking in! I suppose we will find out as I begin my slow taper. I’m currently down to at 15/15 split (for 3 days) no big withdrawals or return flare yet. Will go to a 15/10 split next week. Crossing my fingers! I want off these steroids so bad! I feel like I forgotten what having a normal brain is like.


DX: Sept 2017 -Left Side UC - Symptoms since Jan 2016
Oct 2017 - Renal Cell Carcinoma
Nov 2017 - Partial Nephrectomy
Dec 2017 - Trip to ER - DX: Pancolitis

Current Meds: Prednisone 30mgs taper. Entyvio - Week 5, Probiotics.
Tried w/ no luck: Lialda, Aspiro, Uceris, Cortesol Enemas

Well believe it or not, my GI was able to get the appeal approved to have me try Remicade as a bridge while Entyvio had a chance to kick in. The problem is that it took over 8 weeks to go through the process. I had been on 40 mg of prednisone and now have tapered down to 20 mg. Unfortunately, my symptoms have come rearing back. I’m not back to the 20+ BM’s Previous to pred but, am going 10+ Lots of blood and pain.

I have a appt with a surgeon this afternoon. Based on our last appt, I have a feeling he is going to recommend surgery soon (3-step, because current health) and not want me messing around with the Remicade. After taking a look at my CT scan and rectum, he couldn’t believe I was still able to go to work. I told him it hasn’t been easy, but someone still has to buy groceries.

My question is, am I being rash by moving forward with surgery and not try remicade for a few infusions to truly give Entyvio a chance? Based on Entyvio’s website, it looks like I should see some results by week 10. I’ve had 3 infusions and am just over 8 weeks. Haven’t seen a flick of relief yet. My UC just seems to ignore medication.

My case is a little unique because of my past cancer history. The normal options for biologics are limited because of my higher risk. Entyvio was offered as a “safer” choice.

Yes quality of life is a big part of my decision. Right now, I’m existing but, it is miserable and my patience is getting thin.

I don't think it's rash to consider surgery. It sounds like you've had this illness, and treatment of it, consume a lot of your time and energy. 10-20x a day, with bleeding, while getting to work and supporting yourself and a family, leaves very little time to have a good QoL. Even if entyvio worked, how well would it work, and how long would it last? I am probably alone in feeling this way, and I am aware that surgery can have diverse results, but sometimes it is unavoidable. For me, it has simplified my life, made me more capable and allowed me to move on. I can't imagine where I would be right now if I had continued with treating instead of curing. Yes, I use the bathroom more, but it's quick, painless and not urgent.

Please keep us in the loop. I would love to hear your story as you go through it, and even more so, hear about how well you're doing once you've settled into life with your pouch. It's a tough road, but the road with UC is tough in itself, so either way, there are a lot of difficult decisions, but you're right, the potential of being well after surgery, and living a life without the limitations of UC is very exciting and liberating, not to mention, easier and less expensive. It also seems safer than pumping all these drugs into your body. I know not everyone has a fantastic result, but an experienced surgeon increases the chances of a successful outcome. There are statistics that show over 90% of people are happy with their QoL after.