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Symptoms back while on Remicade

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Ulcerative Colitis
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Posted 1/6/2019 1:09 PM (GMT 0)
My 18 year old son was diagnosed with pancolitis in June. He was put on Remicade and he was completely symptom free and was able to complete one semester at college away from home. Since yesterday he is having blood n mucus in his stools. If there any merit in switching biologics? If one biologic stops working do other biologics usually not work?
Posted 1/6/2019 3:02 PM (GMT 0)
I'd ask his gasteroenterologist about getting an infliximab/remicade blood test done to check his level of that medication and whether there are any antibodies present. https://www.labcorp.com/test-menu/29496/infliximab-concentration-and-anti-infliximab-antibody

about 20% begin loosing response to remicade and increasing the dosage (from 5mgs per kilogram of body weight to 10mgs) and/or frequency of remicade infusions (from 8 weeks to 6 or 4 weeks) often brings patients back into a response.

Other biologics work when failing one, in most cases.
Posted 1/6/2019 3:10 PM (GMT 0)
Hi, these days there are different "classes" of biologics. Remicade is a tnf-inhibitor. If your son has developed antibodies to remicade (can be determined with a blood test) then switching to another tnf-inhibitor (e.g. humira) can be successful. If the flare is due to disease escalation and he does not have antibodies to remicade he may benefit from more frequent infusions or a higher dose. If there are no antibodies and he still does not respond to a higher dose of remicade then he can try switching to a different class of biologics which block a different immune pathway, e.g. entyvio. When you switch drugs classes it's like a clean slate, maybe 40-60% chance of success. Some people on this forum say that chances of success
decrease with each new drug. based on reading published papers I found the difference in success between biologic-naive patients and those who failed another class of biologics exists but is not huge. Definitely worth switching if needs be. Good luck!
Posted 1/6/2019 3:50 PM (GMT 0)
Yup, the doctor can increase the dosage or the frequency of Remicade. If your son has built up antibodies, there are other biologics. I recently switched from Remicade, after 20+ years, due to antibodies and am now on Humira. Best of luck to your son!
Posted 1/6/2019 3:57 PM (GMT 0)
Thank you.
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