Question: Measuring Remicade antibodies and shortening intervals between infusions

Since I started this current flare a month ago, my GI has been trying every possible line of treatment to put symptoms at bay. I saw him again after a week as pain has become unbearable. After examination, he decided my disease is active. So, he took some measures: upped Entocort to 6 mg and decided to let me have Remicade every 4 weeks instead of 6. I'll continue taking both the antispasmodic and painkiller till the infusion is due. I argued about taking the painkiller but he insisted as pain hits me once the effect of both the antispasmodic and painkiller wears off.

My question is: My GI suggested we measure both Remicade trough level and antibodies prior to next infusion. Would shortening the time interval show a high tough level or aren't they related? The last dose I took on the 1st of March did not work at all and that's why I'm suffering. We can't figure out the cause I relapsed. It could be that my disease since it is active this time is more aggressive than Remicade or because it happened that Imuran was not available in my country so I had to lower the dose. My GI says it could be a plausible justification and I still need like a month for it to start working and it could be the cause of the replase. Another reason could be the antibiotic I was given when they suspected malignancy and it immediately threw me into a flare up. Or could just be simply a combination of all the aforementioned causes. Or ... or it could be that I developed antibodies which my doctor was not at ease when I asked him about and that's why he suggested we have the tests done.

Is it ok if after 4 weeks they find that the trough level is high and do they overlook it if the main target is putting the flare up at bay? When I last had the trough test level done, it was 7.2 in week 5. My GI told me then it should be lower than 10 but he'd rather I have a level of 5 or 6 so we pushed it till week 6. Or would a flare up be eating up Infliximab and thus yield lower levels? All these are questions if I have not (hopefully) developed antibodies. There are still a lot of ambiguities about Infliximab that I try to understand.

Minnie,

I am going thru many of the same things right now. My trough level went up to 17 at week 4 or 5, we lowered the dosage from 10 (where it had been for 8 months) to 5. I was ok symptomatically except for the stricture so I missed my September infusion completely. Had surgery and since then have had the trough level measured at the half point between infusions and just prior to the infusion itself. Trough was at 1 and has sloooowly gone up to 3.6. Antibodies dropped like a rock when methotrexate was reintroduced. We had stopped it from July to end of November I think.... ( it still makes me ill but I will deal with it.) Doc thinks without the antibodies the Remicade will start working again and build up my trough amount. The extra methotrexate could also help me go into remission. So far my antibodies have dropped to zero. My symptoms are still bad...just not quite as bad. My doctor believes the antibodies negated many of the benefits of my infusion and additionally caused more symptoms. Now that we have the antibodies down we are going to work on my trough level. He stated that even if my trough level goes back up to 15 or so we will continue with the max Remicade dose every 6 or 4 weeks. Once the symptoms are better and the flare is under control we will work on extending the timeframe and lowering the dose. He believes the flare is causing me to go thru Remicade. He also stressed that Remicade is very fluid...your body is constantly changing as is the disease...so we may have to play with it a bit. For me the flare is bad enough to warrant the higher trough level for a short period of time.

The pain meds...my doc told me to stay in front of it. Once you start feeling the pain the whole viscous cycle starts all over again. I have adjusted my thinking and am in agreement with him.

I just had my last infusion and today it suddenly felt like it was working. It sounds like your doctor is doing the same thing so hang in there.

Clo.

We will be watching out for you Minnie.

Hang in there. I know it will get better for you!!

(((Hugs)))

Clo