Really need advice

If you still remember this year has been really hard. Last November, I developed an allergic reaction to Remicade after 7 years and had to be switched to Stelara starting February 2023. Though most people say that Stelara is a state-of-art medicine, it has not been the case for me. I take it every 4 weeks but it doesn’t seem to be working. A lot of people say that it is a slow burner and I have to bear up with it until it kicks in. Well, on Stelara, I developed a new perianal fistula on top of the old one that has healed on Remicade. We discovered that I have slow bleeding as my hemoglobin level is dropping constantly and started last week iron IV injections. My intestinal pain is at its worst. I take all antispasmodics out there but to no avail. I admit that I abused dexamethasone injections. I took a lot of steroids since I failed Remicade. I’m even now in the middle of a flare up and texted my GI asking for his permission to take dexamethasone injections but he hasn’t replied yet and I don’t think he will as he is against taking any more steroid injections . These injections are the only thing that can put my symptoms at bay. I’m on Entocort but this also isn’t effective. My GI suggested during the last visit that this should be the last time I take Stelara and said I’ve failed it based on the results of my inflammatory markers as they are all high except for CRP in addition to the slow blood loss. He suggested Rinvoq as the next biologic. I can’t believe it that I have failed two biologics in less than a year.
As for my work, as you know I’m a college lecturer, so I asked to have some time off. My GI seconded my decision and also our family doctor as they think that stress could be aggravating my symptoms.
I’m thinking of asking my GI to start Rinvoq right away as I don’t think Stelara would work after 7 months. Had there been any improvement, it would have been shown in my tests. Had you been in my shoes, would you give Stelara one last chance or push to switch to Rinvoq though I have apprehensions regarding its cardiac side effects?

Minnie,

I does seem to be borderline long enough for Stelara. I would be nice to give a few more months, but considering your new fistula, and markers.

I've heard really nothing about Rinvoq. Really hope it's much faster acting, and does the trick for you. Keep us posted, and good luck with it. Seems like a reasonable decision at this point.

I do not know much about biologics. But if you can take some time off from work and change your diet, that might help. Plus exercise such as walking. When you say your inflammation markers are up, are you talking about fecal calprotectin? How high was it?