Prednisone and Remicade

I'll preface my question by saying that I have tried looking for studies and old posts on this topic, but haven't been able to find any yet (forgive me if this has been asked already).

Has it been established whether prednisone can increase the efficacy of Remicade?

I'm aware that adjunct therapy such as Remicade and Imuran or methotrexate has been explored a decent amount, but was wondering whether Remicade taken in conjunction with prednisone could be more effective at inducing remission than taking Remicade alone. Assuming one still responds to steroids, would suppressing the immune system/decreasing production of TNF through prednisone help improve the effectiveness of Remicade by giving the antibodies fewer TNF molecules to which it would need to bind?

I guess I'm essentially curious to know whether one has a higher chance of maintaining remission via Remicade after the inflammation has been tamed with prednisone as opposed to relying on Remicade alone to induce remission.

Trying to figure out whether I'd have a better chance of prolonged remission if I were to take prednisone and Remicade vs. only Remicade.

Any insight would be greatly appreciated.

I don't believe there's any research to answer your question (infliximab adjunct corticosteroids). There's a few general statements that should apply across the board regardless of UC treatment method though: combination therapy works best with UC; it takes more medications to achieve remission than to sustain it.

For me to achieve remission it took: remicade + 6MP + lialda + rowasa + prednisone. I was able to sustain remission with only remicade and 6mp.

iPoop said...
How bad are your symptoms (number of bms a day, urgency, any signs of blood)? What medications are you currently taking?

Thanks for the response. That makes sense--more meds to induce remission, less to maintain. I hate prednisone and was really hoping to avoid taking it, but I guess ya gotta risk it for the biscuit or whatever the kids are sayin nowadays.

I've had four infusions of Remicade (3 during loading phase, 1 post loading phase) at 5mg/kg. While I've noticed a significant reduction in symtoms, I'm still not really close to remission. Bms have been reduced from 10-15 to 6-7, am able to sleep through the night now, have gained ~10 lbs in about three months, no abdominal pain, less bleeding, a little bit more formed bms, etc. Still have occasional blood about once or twice a week and urgency is still present.

Have a scope scheduled soon and am going to add methotrexate to Remicade. Am also going to increase dose to 10 mg/kg and go on what I hope is an extremely short course of prednisone. I hope I'm not on 40 mg too long and can start the taper soon after I start taking the roids.

That would be great. Glad to hear it's working for you. Just hoping I don't mistake the kitchen sink for food while on pred

blksteeda said...
I was eventually getting my infusions every 4 weeks, 10mg/kg before Remicade failed for me

If you had the choice between getting Remicade infusions every 4 weeks or getting a j-pouch, which would you prefer?

If you don't mind me asking, how are your symptoms with the j-pouch? It's something that's in the back of my mind, but I'm not quite there yet. Still hopeful this Remicade, methotrexate, pred cocktail will get me over the hump for what will hopefully be a long remission.

If the Remicade doesn't work, I'm going to pursue a couple of alternative treatments (Since my condition, while not ideal, is not really dire, I want to really exhaust all my options before I pursue surgery as an option. Not necessarily because I completely want to avoid surgery, but more because I over think things and I know I'd always wonder "What if?" if I got surgery without trying something somewhat legitimate.).