Moving from Lialda to Remicade

Zoom,
Have you tried any rectal meds? Either mesalamine or hydrocortisone enemas? Seems like that would be the next step. Wow, 60 mgs of prednisone is a fairly heavy dose for your first time. You may need to do a slower taper off the prednisone. How fast was your taper? It had to have been pretty fast if you were diagnosed 4/1. There are many prednisone taper threads on this forum. Just put in "prednisone taper" under the search link at the top of this page. I would also think your GI would want to try azathioprine or MP6 before moving to on remicade. I would question your GIs decision.

Zoom, not knowing how severe your UC is, or how bad your flares are, it is hard to say what the best next step would be. I would think you would want to try some of the rectals first, maybe try a different 5ASA is the Lialda isn't working, etc.

I know many people try Immuran and/or 6mp first, but for me, my major flares tend to get really bad, really fast, so the first time I went onto Humira (for a trial-Humira is very similar to Remicade), and then this last time, he had wanted to try me on Immuran or 6mp, but I deteriorated too quickly and am now on Remicade. It is working for now, and I am feeling pretty good. Sometimes the immunosuppresants just take too long to kick in in a situation like mine, and I am grateful for the Remicade.

I wouldn't hesitate to try Remicade if you really feel it is warranted, but if you aren't flaring too severely, then I think you are probably doing yourself a disservice if you don't try rectals first, as well as trying to adjust your oral meds as well.

If you are not comfortable starting with Remicade now, ask the doctor for other options. Some folks have success with Colazal than Lialda. Colazal did not work for me. I was on Pred earlier to control my flare and my doctor started with 40 mg with 5mg taper every week. Watch your diet. As others have suggested, ask if you can use Rowasa or Cortenemas. Cortenemas have helped me earlier to control the flare. Also, have you considered taking probiotics - mainly VSL?

I've never been told how severe my UC is, after my scope in the hospital I was told things "looked pretty bad" but that's about the extent of it. My problem is that I have a high tolerance for pain and am completely stubborn, I was flaring I guess for a year and a half before going into the hospital and being diagnosed, the only reason I went to the hospital was because I had lost 25 pounds in 3 weeks and just couldn't afford to be going to the bathroom 20 times a day and lose more weight. By the time I went into the hospital my blood count was 5.9, and I needed 2 bags of blood. Even with all of that, I never really saw myself as being sick so I feel like I just underreact to everything which is why I'm not sure about doing Remicade, I keep thinking maybe I'm actually sicker then I feel. I have never tried rectal meds, and have probiotics but havn't tried them yet. My taper was quick, I was on 60 for a week and a half I think and then it was down 10mg every 5 days.

Zoom-your flare sounds like mine. I go from reasonable to massive weight and blood loss in a matter of weeks. The first time I needed 2 units of blood also-this time I managed to avoid transfusions. And I had been using rectals and probiotics and all of that-it just wasn't enough for me. I also have a high tolerance for pain/discomfort and the like, and I think I let things go too long. I don't recommend it though!!! I completely agree with fargman-and that stubbornness was what landed me in the hospital the first time. (the second time, I tried to get things under control, but it was too late) Stick with the treatments regardless of how you are feeling.

That sounds like a fast taper, especially from such a high starting point. But you also weren't on the high dose for too terribly long. I was on 40mg for 7 weeks and am now tapering-5mg/week until I got to 20mg, and now I am going down 2.5mg/week. It is very slow, same as the last time I tapered, but I am getting off of it without issue, thus far.

I don't know-it is a very personal decision. I would probably want to try a few other things first, but I can tell you the TNF blockers have worked wonders for me so far.