Starting Biologics in remission ?

Hey guys, I’m seeing my Gastro Doctor tomorrow for a general check up and discussion about Biologics. For anyone that doesn’t know, I just come out of a major C-Diff infection which put me in hospital. I also had a very slight UC flare underneath to also combat, which thankfully I have now got rid of aswell as the C-Diff after being so unwell for 2 months. I been in remission roughly 3 weeks now. Now, the reason why we are going to be discussing the Biologics is I have been getting roughly 2 flares a year and whilst the Pred has always got me in remission, my Gastro team are not keen on giving me 2 rounds of pred in a year period all the time. They are happy one course of Pred a year, but anything more they feel another route is needed. I have never been on Biologics but here it’s very successful at getting long term remission and that’s what I’m aiming for, especially with my wedding next year in Italy. I don’t want to be flaring twice a year. Would it be worth going straight on the Biologics even though I’m in remission? Or is it better to wait until a flare appears, then go on it? Obviously I’ll discuss with my Dr, but would like opinions to. I’m currently on 150ML Azathioprine a day and I also take mesalazine.

If you are not well-managed on azathiopurine and mesalazine, then I do think starting a biologic to make your well-managed isn't a bad idea. The one thing that would be hard as you have no symptoms now, is how do I know if starting remicade/humira is actually doing anything at all (a point I would bring up with your doctor)?

You did not mention your dosages or weight, so just a quick checkup on those:

What's your weight in kilograms? Are you about 75-kgs? I weight 165-pounds or 75-kilograms, Azathiopurine is dosed at 2.0 to 2.5 mgs per kilogram. So, my dosage of aza would be 150-mgs a day.

What's your dosage of mesalazine? It really depends on formulation, but you should be on 4,000-4,800 mgs orally per day. There's some variations based on brand (like pentasa granules/satchels are okay at 3,000-mgs a day). Have you considered using mesalazine retention-enemas at 4,000-mgs a day as a maintenance treatment?

Oh and I take nightly pred enemas to for maintaining remission. Will slowly come off them in a few months thigh like I usually do when in remission

Aza dose is good then, mesalazine might be a little low (but might be fine depending what brand). Steroids have a cumulative affect on us, I have osteopenia (the lesser cousin of osteoporosis) due to being on pred 1.5-years-cumulatively. The rectal route steroids are, of course, safer than pred but still if you're talking over many years and taking steroids twice a year, then that's not a very good place to be in.

Certainly a much harder choice to go on biologics when overall feeling well. If you're struggling and flaring badly then it is always a much easier choice.

Yeah, tough decision since you won't know if they're doing anything. Good luck!

Also another question. Is it safe to take both Azathioprine and Remicade? Obviously I’m on AZA now and have been for years with no issues. Will they take me off the Aza to put me on the Biologics treatment?

Thanks Sara. Yeh I’m a little concerned messing with my bowl whilst I’m doing so well but my Dr reassured me there is no evidence whatsoever that a colonoscopy causes a flare up and reassured me it will be fine, but said it’s important I get the scope as I have had the disease 8 years now and my only scope was when I was diagnosed.

TBlock, my gi puts his patients on Imuran with Remicade & Humira, alot of them do this. Relying on pred only with flare ups is not good on a long term basis. It's better to start something now rather than waiting for the bottom to fall out.

My dr says the same as yours, the prep does not cause a flare, if there is inflammation present it can aggravate things. And the prep can make us feel funky for up to a week. You are long overdue for a scope.

Take care.

Yeah super common combination to take thiopurines (azathiopurine/imuran/6mp) and biologics simultaneously. I'm on 6mp and remicade simultaneously.

Just remember entyvio is slow acting so you might want to stay on your rectals for 2-3 months!

Good luck! I’ve been in remission for over 2 years on entyvio. No side effects or problems.