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Taking Xeljanz while going on 3rd induction of Entyvio

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Ulcerative Colitis
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Posted 10/23/2018 7:51 PM (GMT 0)
I am new to this forum. My son is 17 (18 in 4 months) he was diagnosed 3 years ago. He was on all of the other medications(pentasa, Lialda,) which stopped working. Went on to Simponi, Remicade and is now scheduled for his 3rd Entyvio infusion as part of the induction. He started that 10 days after his 7th Remicaid that had stopped. working. We were told to have him start weaning off of the Prednisone(20mg) a day. And get a blood test to start Xeljanz. I researched it and I am a little concerned and I don't know how to question his Dr. without insulting him. This is what I read.
It is not recommended that Xeljanz be given at the same time as immune-suppressing medications or those that are in the drug class called biologics.
Immunosuppressive medications given for ulcerative colitis may include Imuran (azathioprine) and cyclosporine. Biologics approved to treat ulcerative colitis include Entyvio (vedolizumab), Humira (adalimumab), Remicade (infliximab), and Simponi (golimumab).

Anyone else have this experience. I worried about side effects especially infection.
Posted 10/23/2018 8:14 PM (GMT 0)
Welcome to the forum! Well the risks for Xeljanz are no different than they are for remicade, so you're not at all talking about anything new or different. Same safety profile, same risks, same benefits (all have rare odds of causing a severe infection, etc.).

Xeljanz is pretty new, approved for UC within the last month or so, so it is not entirely surprising that many web resources do not mention it. We have some regular posters who got Xeljanz off-label before that approval, either through clinical trials or by doctors who also used Xeljanz for other approved and similar illnesses.

All of the biologics have some similar warning about taking other biologics simultaneously. You're supposed to take only one biologic at-a-time for the treatment of his UC. That's what his doctor is doing, switching from one biologic to another, which is perfectly allowable and normal.
Posted 10/23/2018 9:49 PM (GMT 0)
I started Xeljanz 12 days ago after Remicade was ineffective. We stopped Remicade and I started Xeljanz, all while on 40 mg of Pred. Now tapering.... at 10 mg Pred and we've stopped being solid with the BMs, so hoping that that changes so I can get off of Pred, which is the goal, but to your question, Xeljanz was started and Remicade was stopped. Double biologics might be too much as the warning label says for one's immune system IMHO. So far for my severe pancolitis, Xeljanz is the only thing working besides Prednisone...
Posted 10/24/2018 8:19 PM (GMT 0)
Thank you for your responses. They are helpful. He has an Enyvio infusion on Nov 8th and he is weaning off of the prednisone to go on the Xeljanz. He has to get a blood test before the Xeljanz begins.
Posted 10/24/2018 10:34 PM (GMT 0)
If the entyvio is not working, I would discontinue it before starting another medication.

I didn't respond to any drugs, and ended up having j-pouch surgery, and life is so much better now. I can actually live life without worrying about the toilet every second. My situation was severe and non-responsive though, many cases do not warrant surgery.
Posted 10/25/2018 2:17 PM (GMT 0)
It's just not an ideal situation unfortunately. The key is that you don't want him to get any worse before he can get better. If you waited for all of the entyvio to leave his system before starting xeljanz that may happen. You could see if you can start xeljanz 1-2 weeks before next the scheduled entyvio to minimize risks.
Posted 10/25/2018 4:21 PM (GMT 0)
Please don’t ever hesitate to ask your Doctor questions. A good Dr. will never be offended by it. If they are, switch Drs. To address your question, unlike prednisone (which suppresses the entire immune system), Entyvio targets only the colon areas autoimmune system. So it might be safer to add another immunosuppressant to it. It’s a good question to ask your Doctor.
Posted 10/25/2018 5:11 PM (GMT 0)
I am in the process of switching to Humira and was told to go ahead and get my infusion on Saturday as usual so I was still being treated and that since Humira is a totally different class of biologics than Entyvio I wouldn't have to wait once Humira is approved to start it. I hope that's true, but I have been given a lot of misinformation from the physicians assistant who told me this so I have no idea. My brain hurts (figuratively, not literally lol) just from dealing with all the pre approval mess that I decided just not to think about it anymore. One I get the approval for Humira I'll deal with the next step.
Posted 10/25/2018 6:30 PM (GMT 0)
Many switch without a delay/waiting period, between biologics. Why? Because detectable levels of remicade were found in patients 12-weeks (3-months) after their last infusion and discontinuation (and it's perfectly reasonable to expect other biologics to stay as long). It takes a long, long time to clearance all of a biologic from your body, 6-months or more. Can you wait a week or two between them?, Sure but it isn't going to really do/accomplish much. Over time, the levels/concentration of the old biologic drop and become less and less of an issue.

Post Edited (iPoop) : 10/25/2018 12:34:51 PM (GMT-6)

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