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Effect of Remicade tapering

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Ulcerative Colitis
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Posted 8/7/2018 1:30 PM (GMT 0)
My son was diagnosed with severe pancolitis recently and he has been getting Remicade infusions. After the second infusion his symptoms improved and the bleeding and mucus stopped. But towards the end of the fourceeel period when his next infusion is due, the bleeding came back. We are also tapering prednisone by 5 mg each week. Have u all seen the effect of Remicade tapering off towards the end?
Posted 8/7/2018 1:45 PM (GMT 0)
It's common to see a waning affect while going through the remicade loading dosages. What they're trying to do is get his concentration of remicade high, and until it's built up to sufficient concentration for maximum thereapuedic (healing) affect. So, you might see that response fade a bit. Remicade dosing is variable though, so they can do double-dosages (go from 5mgs per kilogram to 10mgs per kilogram).
Posted 8/7/2018 4:01 PM (GMT 0)
He is supposed to get 10 mg every 8 weeks. Is the third dose still a loading dose?
Posted 8/7/2018 4:18 PM (GMT 0)
Yes, dosages 1 (at zero-weeks), 2 (at two-weeks), and 3 (at six-weeks) are all considered to be loading dosages. Starting at dosage 4, he would be on an eight-week infusion schedule by default. Although, some of us require shorter intervals during maintenance (I get infusions every six-weeks as an example, and some get it every 4-weeks).

Is remicade the only medication that he is currently on? Or are there others?
Posted 8/8/2018 12:00 AM (GMT 0)
He takes Methotrexate 14 mg once every week which the doctor mentioned was to keep the Remicade working. He is trying to taper off prednisone and is on 20 mg now from 40mg.
Posted 8/8/2018 2:31 AM (GMT 0)
I've heard from some well-known IBD doctors that severe pancolitis in particular can require a lot of Remicade up front in order to get in under control. They've talked about doing more than the standard loading dosing schedule at the beginning. That might be something to consider.
Posted 8/8/2018 3:05 AM (GMT 0)
Ok thank you for letting me know, I will bring that up with his doctor in the next visit.
Posted 8/8/2018 12:29 PM (GMT 0)
And a statistic to remember is only 65% respond to remicade, so it doesn't work universally work for everyone. Too early to call remicade a failure, but it's important to remain pragmatic and move on should it come to it.

Another tool at your disposal is a blood test to measure his minimum remicade/infliximab concentration and antibody levels. It's a dosing guide, to tell if he has his optimum levels of remicade/infliximab needed to heal. These tests aren't essential (a doctor can try an experimental higher dose without this test), but are a good helper when you're not sure what's going on and need some data to backup your decision. Prometheus Labs in Ca invented the test and still charges a premium for it, they call it Anser IFX /www.anserifx.com. You can also get this test as a generic from LabCorps and a variety of other labs: /www.labcorp.com/test-menu/29496/infliximab-concentration-and-anti-infliximab-antibody
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