Which drugs should i start with? Stronger or weaker?

I personally think starting off weaker and getting stronger is the best way. If you start with the strong drugs like remicade you're then committed to it when a weaker, simpler drug could have done the job.

Back when I was first diagnosed the way treatment was started was steroids + a pentasa type drug, if that didn't do it than move up to the immuno-suppressents such azathioprine and methotrexate, if they didn't work and surgery was unsuitable then you'd be put on a biologic (remicade).

Now they put people straight onto Humira, been trying to convince me to go onto that as well....problem is theres now a lot more interference from drug reps in the NHS which unsettles me a lot!

I'd say if you were severely struggling - bedridden etc then jump straight to the strong drugs rather than waste time. But if you're kinda coping start off weaker and see how it goes.

I would say it depends on the case. Since you're doing well, start with the milder ones to attain and maintain remission. If someone is doing poorly I might go higher sooner to knock it back quicker.

To give proper advice, I think it might be helpful to know where your active CD is located (colon, ileum, etc.), what kind of symptoms you are having, and if your doc thinks you are at risk for complications, like a stricture.

Anyways, it is 100% a personal choice and depends on what you are comfortable with. These options are the "top-down" versus "step-up" approach to Crohn's. If you google those terms you will find articles discussing the merits of both and that might help you decide.

Right now there is not solid evidence that going on stronger drugs immediately will help in the long term. BUT it will get you to remission faster--that's just common sense and it's clinically proven. Usually it's a good thing because the patient has disabling symptoms and just wants relief.

Now that you are diagnosed you should do something. If you are not experiencing severe symptoms and the doc is giving you a choice, my gut would say to go with the weaker drugs if he is offering something like antibiotics or Entocort followed by a 5-ASA, imuran/6mp, or nothing just to see what happens. I agree that it's better to save the heavy hitting drugs for when you need them. But if the choice is prednisone versus Remicade or Humira... some might argue it is better to be immunomodulated versus totally immunosuppressed, and pred does have some gnarly side-effects of its own. In terms of the risk of cancer and infection, that is something you have to weight against the risks of untreated Crohn's...which can also lead to cancer, emergency surgery, etc.

i disagree. Starting weaker means going stronger because active inflimation is running its coarse.. starting strong means possible long term remission.. i dount you would go weaker. a lot of good new drugs coming out.

My doctor started me off with Pentasa and I've been working my way up. In my opinion, this is the best way to treat the disease, because I'd rather not deal with potentially serious side effects unless I absolutely have to. Pentasa didn't work for me, Entocort helped me significantly, and a combination of Cipro and Flagyl has helped me get rid of the rest of the pain I have had. So far, this has been successful for me. My next option is Imuran/6MP. I know that this can cause the inflammation to fester longer, but unless you spend forever on each drug working your way up, I'd much prefer this to dealing with nasty side effects (I haven't had any side effects so far). I was on Pentasa for under a month (I had a nasty reaction for it) and I've been on Entocort since March of last year, and the Cipro/Flagyl for about a week now (I've got a 3-month course of them to take). If you start with a weaker med like Entocort, I would suggest that if your symptoms haven't started to improve within the first month, you move up to Prednisone. Just my 2 cents!

They have treatment algorithms/protocols depending on where your disease is located, your symptoms, etc..... While, I totally respect a doctor who wants me to be on board with the treatment and gives me some choices, I like someone who is somewhat decisive, even if we disagree. lol.... The safe approach is to start out with a milder drug if you are not too sick, your doc should know this. Do some research on good sites. I saw the Johns Hopkins site that njmom gave us a link to and it was very informative. I think we all face this at some point in time. My doctor started me on colazal because it was one of the mildest drugs and I am allergic to sulfa. While I felt pretty miserable, I was not nearly critically ill with any of the complications like strictures and fistulas. For that, I am grateful. With that said, my meds quit working and so we are facing the same situation about meds. They are re scoping me tomorrow to see what's up. Good luck to you!! Welcome to the forum, it is awesome!!!

thanks for that excellent link njmom

Sheep I just wanted to add that whatever decision you make whether it is the weaker meds or stronger, be sure to always take your maintainence meds even when you start feeling better. This helps to keep the disease under control and to stop and keep it stopped with continually taken your meds. As for diet, whether its a low res diet, SCD or whatever should be continued also along with the meds to help you feel your best. But meds and diet should always be considered as complimentary of eachother. Good luck with your test, and let us know which way your doc is going. Hugs!

I need to bump up my meds from Pentasa. I'm going to go with Imuran. My plan is to get a colonoscopy in two years and if my disease has progressed, to then bump it up to a biological. That's Plan A. If I don't make it to the two years, I'll go to Plan B or C. This is my second time chosing to start with the weaker meds and work up, if necessary. (After my resection, I started over again with Pentasa. After almost 2 years on Pentasa post-resection, I'm going to start Imuran).