Jessa33 said...
For those who took that next step of immune suppressants, are flares not as bad now? If I am flaring so frequently would you ask for increased meds anyway even if all looks quiet at the moment?
Everyone eventually flares up, regardless of their UC treatment. So, there's no escaping that fate (except for our j-Pouch friends). Generally speaking, if you have an appropriate maintenance treatment then when you flare it will be milder and shorter than if your UC isn't well treated. Can immunosuppressive medications guarantee you will never had a severe flare? No, nothing can. However, if your UC doesn't get any more severe and you are aptly treated and in a good, solid remission than your odds of flaring badly are decreased and more likely to be infrequent and milder flares.
If you've been flaring regularly then it makes sense to look into immunosuppressants if your scope comes back bad.
The first class of treatment for UC are the topical, anti-inflammatory mesalamines/5ASAs, which you have tried. If that's not enough than adding some sort of immunosuppressant is the next approach in both the second and third classes of UC meds. The goal is to slightly weaken the immune system so you can heal and your UC symptoms improve. It's important to emphasize that it is a slight weakening and you don't have to become a total germaphobe or be constantly afraid of being sick.
The second class is immunomodulators (imuran/Azathioprine or 6MP), which intentionally lower the amount of White Blood Cells (WBC) within your body. When we flare our WBC count goes through the roof beyond the normal rages in our blood tests, as our immune system uses WBC to directly attack and cause inflammation. Imuran/6MP will slow the rate in which your immune system can create WBC, reducing the total amount of WBC your immune system can use for an attack. The less WBC you have, the less formidable of an attack your immune system can attempt, and the better your UC symptoms will get. For the pros, Immunomodulators are available as generic pills that you take orally, and are less expensive than the mesalamine and biologic meds are. For the cons, these medications take 2-3 months to reach full effect (very slow working) and you must have routine bloodwork to make sure your WBC doesn't get too low (initially biweekly, then reduced to monthly, bimonthly, and remains at tri-monthly the duration you are on these medications). You will get a Complete Bloodcell Count (CBC) blood test to keep an eye on things.
The third class of UC medications is biologics (remicade, humira, simponi, and entyvio). These are biologically-engineered proteins that are put into our bloodstream to interfere with our immune system's abilities to signal, initiate, or complete an attack. Our immune system creates a series of messenger proteins that are used to say things like "hey send and attack over here", and in the case of the tnf-alpha-blocking biologics (like remicade/humira), that's what they target. The process is a remicade protein intercepts an immune system protein whose purpose is to signal a battle-cry for an attack, and inflammation is blocked. With sufficient proteins you can entirely block or at least muffle the battlecry for an attack and your UC symptoms will improve. Other classes of biologics block other stages of the attack through different tactics. Pros, biologics are very quick working medications with responses in 6 weeks or less and they do not require routne bloodwork. Cons, biologic are given via a self-injection or IV, and are very expensive brand-named medications and most of us rely on manufacturer issued patient copay assistance cards to cover their complex billing.
It really depends how bad you scope is. If you have mild/moderate inflammation that isn't a huge problem with your symptoms, then I'd argue for the 2nd class immunomodulators at a low dose as you can wait for them to work and they are much cheaper. If you have severe inflammation and need a quick solution then biologics are often used in that case. Regardless of how the scope goes, just remember that UC responds best to multiple treatments simultaneously, so your new medication doesn't entirely replace what you are taking now, rather it is additive to what you are taking now. There's seldom a single treatment that is perfect for us, rather it's often a combination of meds that produces the best results!