Failed all immunosuppressants

I had been on Azathioprine for 7 months but it turned out to be ineffective. So, I was switched to Imuran which caused me a severe flare up. Then, I was put on Methotrexate im injection 25 mg weekly. I was doing extremely well esp. after it was paired with Entocort. This lasted only for 5 months until last week when MTX brought about a severe stomach flare up accompanied by nonstop vomiting and nausea and for which I'm still on iv fluids and injections. Accordingly, my doc decided to stop MTX completely. I was worried but he assured me that I'm covered with Entocort (my proctitis is now flaring(:).

So, I have 2 questions:

1. Can Entocort be used for long-term treatment? My doc assured that there are patients who can take it for many years. The fortunate thing that this flare up caused is that I got rid of pred after one year and a half. But it seems that my body responds only to steroids.

2. What other treatment options are left? I know that the next line will be biologics of which my doc seems to be in favour. I'm just wondering , am I going to fail them like the immunosuppressants but I'd like to continue with Entocort and don't want to start biologics at the time being.

Your replies are highly appreciated.

Alistair,

I am curious..why do you put surgery as a second option.  I think that should be your last option.  Also, you have forgotten clinical trials as an option.  The only catch there is that you have to have tried all the types of meds out there so you would have to do biologics first before any trial.

 

JavaJay said...
Alistair,


I am curious..why do you put surgery as a second option. I think that should be your last option.

Because 95% of the time, surgery is far less risky than a stem cell transplant (which carries a mortality rate of approximately 3%).

On the other hand, I think you should try the combined antibiotic therapy before you even try biologics - the only reason I put it last on my list is because most doctors aren't very experienced with treating Crohn's disease with antibiotics.

But, if you want to go down the antibiotic path, the first step would be to take a sensitiveness test for ASCAs, anti-AIECs and some other bacterium whose name I've forgotten.

Then, depending on the test results, your doctor prescribes you the appropriate antibiotics, which should be at least two and preferably three different antibiotics.