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Increase Prednisone?

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Ulcerative Colitis
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Posted 8/28/2018 1:07 PM (GMT 0)
Hello, I was diagnosed with UC about 5 weeks ago. Since my case was pretty severe at the time, I was put on Remicade and prednisone. Right after the first Remicade infusion I saw a great improvement - no urgency, formed stools, going once a day, no abdominal pain. It was going well. During this course I was on 30mg of Pred for a week, then 20 for a week, then 15, 10, and 5. However right when I got to 5 mg of Pred, I started to see blood again and the stools became less formed. Is this a result of tapering the Pred too quickly or the Remicade (I have a week until my third infusion) wearing off before the next dosage? Should I increase the Pred to a higher dosage? Thanks.
Posted 8/28/2018 3:19 PM (GMT 0)
Hi Aidan

I had a very similar situation prior to my 3rd loading dose. I went back up to 10mg until after the 3rd dose and then went to 7.5 for a week, 5, 2.5 and then off. I also added Balsalazide back into the mix. You had a good response if you were able to wean to 5mg of prednisone, but you need a little more time. I have finished my loading doses and am in the waiting period for the 4th dose which may be moved up a little sooner. While the blood has stopped, I am still having a few issues.
Posted 8/29/2018 2:11 PM (GMT 0)
I'd increase the pred, give it a few more weeks and then try a slower taper.

Remicade dose and frequecan be increased to maintain a sustained response.
Posted 9/5/2018 2:33 PM (GMT 0)
I've been through 4 Remicade treatments (5mg/kg) and never been able to go lower than 20 mg of Pred. I'm currently at 30 mg of Pred and bleed slightly in the morning, have 10-12 BM a day, pseudo formed/liquid... urgency manageable, but still accidents, so I don't leave home without depends... Switching to 10 mg/kg Remicade for 2 doses before making the decision to switch to Entyvio in hopes I can get off of Pred... Rest of meds in signature... so, in short, your experience seems common to me. My DX is severe pancolitis
Posted 9/5/2018 3:09 PM (GMT 0)
Remicade didn't do anything for me. about 60% of people "respond", then within that 60%, there are varied levels of response. A response can mean limited improvement, it doesn't necessarily mean remission. The fact that you had a quick response is a good sign. A dose adjustment might take care of things. The fact that you're on pred, makes it difficult to know whether it was the remicade, or the pred that helped.

Since you're so new to UC, you definitely need to try everything. How were you diagnosed? Scope with biopsies? Did you have stool tests? I'd want to run the gamut of tests to ensure a proper diagnosis. It sounds like the doctors are trying a top down approach, but I don't think you should give up on trying any of the options, even if Remicade doesn't work for you. Some people need the lower level meds in addition to biologics to see improvement.
Posted 9/5/2018 5:01 PM (GMT 0)
And remember that often combination-therapy is best. Often, no single medication gets us to 100%. Rather, we take multiple medications simultaneously in order to achieve a remission. You might need to be on Remicade, and imuran/6mp, and mesalamine to achieve a remission.

It often takes less medications to sustain a remission then to initially achieve a remission. Expect those meds to be reduced once you're in a sustained remission.
Posted 9/8/2018 7:49 PM (GMT 0)
notsosicklygirl - i’m pretty sure the positive response was due to the remicade, since I was put on IV steroids before the remicade for about 5 days and there was little improvement. Then right after the remicade i was doing great. So, i’m assuming the remicade is the one that was doing the trick.

And yes, I was diagnosed via a colonoscopy and confirmed through biopsies. I also had stools tests that showed inflammation as well as blood tests that showed high inflammatory markers.

iPoop - I agree, I think i need to try more meds to help me. Unfortunately my doctor hasn’t mentioned combination therapy for me but i will be sure to mention it to her the next time i speak with her.

Things have taken a turn though, after my third infusion i didn’t see as good of a response as the first two infusions. It’s diarrhea right now about 3 times a day, and my infusion was 3 days ago. I hope this is just a delayed response. There is occasionally blood but not all the time.
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