Sigmoidoscopy confirmed humira not working

My daughter recently got her sigmoidoscopy done which confirmed that humira is not working which she was taking weekly. It has helped her stop bleeding and control bowel movements but since she started humira a year ago...80% of her ulceration disappeared by the last 20% in the sigmoid region are stubborn and no change sine last 6 months...due to which she had developed fistula and now has a seeton....have the doctors appt on Thursday...biting my nails off in worry.... Any advice?
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Daughter dx with crohn in 2012
On immuran, lialda and humira weekly

Remicade could be your answer. I have been in this same battle with periannal crohns for 34 years and I have tried everything. The only med that helped was remicade. I tried cortifoam, suppos. etc.. This is a very hard area to heal, but it did heal a crohns ulcer the size of a 50 cent piece for me.

All the best,
Julia

I second a mesalamine suppositories and perhaps also cortifoam suppositories (steroid). My husband is on remicade, canasa suppositories, and lialda. There is a new steroid called uceris, which is basically entocort but survives all the way to the colon. It is supposed to be less systemically absorbed than regular pred, so it should have far fewer side effects. Neither the steroid suppositories nor the uceris is a long term maintenance drug, but sometimes you just need something to kick the disease into remission, and be able to maintain remission with just humira.

I would give these options a try before I added another long term immunosuppressant medication like MTX or 6mp or imuran to the mix.

I hope she gets to remission soon.

No, you just slip it up your butt like you do hemorrhoid suppositories. Also, I don't suggest systemic steroids either (like oral pred). My husband had osteopenia of the spine after being on high doses of steroids for over a year. But for my husband it was unavoidable, I don't think your daughter is there. The steroids I suggested act more like topical applications in the colon, and only a little is systemically absorbed.

Kazbern... How does that work? Sorry to be dumb but I am just learning....

How much imuran is she on? Has her doctor done blood tests to confirm she is in the therapeutic range for imuran?

Mesalamine enemas might help some with the inflammation, but if she already has a fistula in that area, they'll be of limited benefit, IMO.

I think she needs to make sure her levels and doses of imuran and humira are optimized before doing anything else.