pred vs. immunologicals and biologicals

I'm going to answer these backwards.

Pred is often prescribed first to try to get a flare under control. This is for two reasons. First, the other drugs (biologics/immunsuppressants) are commitments. You HAVE to stay on these long term, while you can finish a course of pred in two months. The other drugs you need to stay on more or less permanently, and you really have no option of going off remi/humira if you ever want to take them again. Second, pred works FAST. A patient in a bad flare might not have 6 weeks to 3 months to wait for imuran/6mp to kick in, or for remi/humira to get approved. Third, pred is dirt cheap. Imuran is not too horrible but for the biologics the cost is astronomical. Even for the immunosuppressants, the out of pocket cost is 70 or so for a month versus about 2-3 dollars for a course of pred...the insurance companies actually MAKE money with prednisone copays. It's so cheap I know engineers that use it to calibrate their instruments.

As per side effects, I can't speak for biologics but the side effects for immunosuppresants are nearly nonexistant. The most common seem to be fatigue, sun sensitivty, and bruising. Plus bloodwork helps you stay on top of the invisible side effects.

I just received the guesstimate from our infusion center that a year's cost of Remicade will be between US $19.000 and $22,000. I don't know how much our insurance will cover.

First of all that's not true in regards to docs using pred until it doesn't work.  I have talked to many doctors who may use prednisone to reduce the inflammatory response but one they realise that the patient is steroid dependant then and only then do the immunomodulators and bioligics come out.  Meaning pred still works but no should be on it indefinitely.  Also there has been a movement to do a more top down approach in terms of treating UC.  Many people (gi docs) now prefer to treat more aggresively with immunomodulators or biologics than with the standard asa and pred combo.  One doc I talked to said that once a pt has to use steroids more than 3 times for flares while he is on a asa med out comes the immunomodulators and biolgics.  As to side effects we all the prednisone side effects, if not I will contribute in another post. 

MyUC

re side effects immunosuppressants (Imuran, 6MP, Azathioprine):

-While the side effects compared to prednisone might not be as outwardly obvious - these are still very serious possible complications including cancer and liver damage.  Imuran gave me serious liver problems and I was very ill.  This is uncommon but worth noting. 

The biologics can be no walk in the park either.  You need to put a lot of thought into these drugs and get well monitored.