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Remicade or Entyvio?

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Ulcerative Colitis
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Posted 3/30/2018 12:00 AM (GMT 0)
Hello. I was diagnosed with pancolitis about four months ago. Initially I received Lialda and Prednisone. I did the pred taper over a little less than two months. Two weeks after starting meds I was in complete remission. about a month after completing the prednisone I started to see small amounts of blood. Now I'm dealing with mucus as well. Currently I take Lialda 4.8 g, and I do mesalamine enemas daily. Also I have been strictly doing the SCD diet for almost four months.

Anyway, even with everything I'm doing I'm still slipping back into a flare. So, my next step is to quit everything I'm doing and start Remicade or Entyvio. What do those with experience with either think? What side effects should I look our for?
Posted 3/30/2018 3:16 AM (GMT 0)
I didn't try remicade. I have been on entyvio for a year with infusion #9 tomorrow. I am symptom free. Up until infusion 8 I was occasionally having some very mild symptoms like mild urgency and 2-3 bms but it was only occasionally. I was greatly improved on entyvio after the 4th infusion. No side effects except maybe headaches but hard to tell if those were from entyvio or not.
Posted 3/30/2018 12:34 PM (GMT 0)

rafaeltoral said...
Anyway, even with everything I'm doing I'm still slipping back into a flare. So, my next step is to quit everything I'm doing and start Remicade or Entyvio. What do those with experience with either think? What side effects should I look our for?

First, I wouldn't quit everything you're currently doing, they're working but not enough by themselves and need a "helping hand" added to them.

Either biologic has about the same odds of success (about 65% respond to them and have improvements within their UC symptoms). I'll describe some pros and cons of both and you can check with your doctor and insurance and see what makes the most sense. For me personally, I've been on Remicade since 2012 and it has worked well for me and given me a remission with no side effects. Some here are on entyvio and it has worked well for them as well.

Remicade is the hare and Entyvio is the turtle in the rabbit/turtle race. You'll get a response in 3-6 weeks or less from Remicade. Entyvio can take 12-14 weeks or less for a response. If your flare is mild then Entyvio is fine, for severe flares Remicade would be the recommendation.

Remicade was the 1st biologic approved for treating UC, has a long safety record and many have been on it for 8-10 years or more. Remicade is systematic in suppressing your immune system, and infections requiring antibiotics like bronchitis, sinusitis, UTI and others are going to hit you harder and last longer. Entyvio is a site-specific-immunomodulator affecting only your digestive tract, so systematic infections are less of a concern (however, you still have increased risk of GI-based things like stomach flu), it's a newer more advanced medication (should be safer but there isn't a decades long safety record behind it).

Some insurance policies require you to first try a tnf-alpha-blocker class of biologics (remicade/humira/simponi) before going to entvyio, as the older tnf-based medications are cheaper. If they require one before the other than that makes your choice easy.

Both medications have patient copay assistance programs that are great. I've been using RemiStart for years and it lowers my out-of-pocket cost to $5, every 8-weeks. Entyvio has a similar program available. The billing is more complex, both are IV-infusions given as a hospital-outpatient procedure. You might have hospital deductables or copays that are different than what you have now for oral-mesalamine.

Remicade patient assistance:
/remicade.janssencarepathsavings.com/#/app/home

Entyvio:
/www.entyvio.com/financial-support
Posted 3/30/2018 3:40 PM (GMT 0)
Have you had stool tests? Prednisone can open you up to getting infections, and it is possible you're dealing with something in addition to your UC. I also wonder where the UC is active. Maybe a biologic is jumping the gun if it's in the rectum and there's the possibility of using stronger rectal meds to get things headed in the right direction. There is also the possibility of trying something like imuran or 6mp. You might need a bridge of Uceris, or pred. Uceris is sort of a topical version of prednisone that works in the colon, and has minimal systemic effects. That alone could help you, but like pred, it's not a long term solution, so you would need to figure something out for maintenace.

As iPoop said, Remicade & entyvio are different drugs. When I read about the two, I think "entyvio of course", but he's also right that sometimes insurance companies make you try one or the other first. Often if you have this stipulation on your plan, they would likely require you take a self-injectable, which would be humira or simponi. Both of these are okay options too. The reality is, remicade helps about 60 - 65% of people with UC. Entyvio's response rate is lower, maybe 40-50%. Simponi and Humira, are very similar to remicade, but since the syringes are prefilled, you can do them at home, and the dose is not adjustable. So far as commitment, Remicade is the worst. It takes multiple hours in a hospital or infusion center. Entyvio is about 45 minutes in a hospital/infusion center. Simponi/Humira you can do at home quickly.

SCD diet is great, but there is really no evidence it treats UC. If it helps your symptoms, that is good.
Posted 4/3/2018 8:51 PM (GMT 0)
As the others have said, you shouldn't "quit everything" - Usually GI's will always have some form of a prescription cocktail to bridge you onto your infusion and slowly ween you off as you get further into your treatment.

Remicade murdered my liver in one dose. After my enzymes came back up after a month or so, I was placed on Entyvio. I'm on infusion #3 right now, and I'm off of my bridging medication. I have some mild symptoms but people typically don't see the full benefit until infusion #6 or so.

Not one thing works for everyone - Your GI's will find what's best for you and your situation. I enjoy Entyvio because it's gut-specific in preventing/stopping inflammation. Do some homework and see what piques your interest.
Posted 4/4/2018 5:08 PM (GMT 0)
Choice of biologic is an individual thing. Remicade didn't help me much, if at all. Entyvio has stopped a flare that nothing else but prednisone could. Your experience may be the opposite. As mentioned above, often insurance companies will insist you try Remicade or Humira before moving on to other biologics.

Good luck!
Posted 4/7/2018 6:06 AM (GMT 0)
Insurance (Blue Cross) required me to try and fail Remicade and Humira before getting Entyvio. Entyvio has worked much better for me, but none of these had significant side effects for me. Improvement with Entyvio was slow. Noticeably better in a couple of months, but improved fairly steadily over a year.
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