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Switching to a different biologics from Remicade

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Ulcerative Colitis
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Posted 4/3/2019 11:41 AM (GMT 0)
My son is in college n he is on Remicade n methotrexate since his diagnosis last year. He was diagnosed with moderate to severe pan colitis. He was doing great but recently his symptoms are coming back. He had a colonoscopy two weeks back and he is 90% healed but there is inflammation in the lower part of the tract. Doctor suggested switching him to Xenijanx and he said the process might take two months? I am just wondering how do people usually handle the switch?
Posted 4/3/2019 12:23 PM (GMT 0)
If there is only inflammation in the lower part, the rectum, then have enemas been discussed?
Has he had a remicade antibody and concentration blood test done? It's possible increasing the dosage and frequency might bring him back into response.
Posted 4/3/2019 12:25 PM (GMT 0)
I switched over from Entyvio to Xeljanz just over a week ago and it is working out great for me..
Certainly very convenient to pop a pill twice a day rather than going for infusions.
No side effects to report just a good experience.
Geoff
Posted 4/3/2019 12:56 PM (GMT 0)
I agree with Ipoop, I’d try to adjust the dosing first before moving on because it was working so well for him. Once you go off of Remicade it is difficult to go back on it.
Posted 4/3/2019 2:06 PM (GMT 0)
Hi i switched from entyvio to xeljanz, as I'm neurotic i did the switch only 12 days after the last infusion. It took a few weeks before i felt a significant improvement, so symptoms were hovering around the same level for about 5 weeks before they got better. I also only had inflammation in the end part of the colon (having previously had pancolitis)but it was pretty severe. And before entyvio i had tried infliximab at both 5mg/kg and 10mg/kg. Nothing touched that last part of my colon until i tried xeljanz.
Posted 4/3/2019 2:06 PM (GMT 0)
Thanks for the responses.
The doctor did mention enemas but he is absolutely resfusing to use suppositories or enemas. The doctor suggested taking oral asacol but that is not really helping much.
We did do the antibody test n checked the level of Remicade in his blood; the level is fine and no antibodies. His scope was done one week after his infusion n there was visible inflammation, so it is not the level of Remicade
Posted 4/3/2019 2:09 PM (GMT 0)
Ps i had no antibodies to infliximab and it was at ideal therapeutic range, but the hospital still tried to double the dose to 10mg /kg before switching to another drug
Posted 4/3/2019 2:21 PM (GMT 0)
Is he using 6mp/Imuran/azathioprine along with the remicade?
Posted 4/3/2019 2:25 PM (GMT 0)
He is not, he has been taking Asacol for the last two weeks but it isn’t doing much.
Poopydoop thank you, is xenjanx working well for u?

Post Edited (mamabear18) : 4/3/2019 8:28:27 AM (GMT-6)

Posted 4/3/2019 2:43 PM (GMT 0)

mamabear18 said...
Thanks for the responses.
The doctor did mention enemas but he is absolutely resfusing to use suppositories or enemas.


I didn't start using enemas until after college even though my doctor suggested them a few times. Even once I started it took a while to get over the idea of it. But now I'm totally used to it and they really help. I wish I had been convinced to use them earlier, but I don't know that I could have been. College is a weird time.
Posted 4/3/2019 2:52 PM (GMT 0)

iPoop said...
Is he using 6mp/Imuran/azathioprine along with the remicade?

He is using methotrexate.

How about an oral steroid like Entocort? Fewer side effects than Prednisone but not as potent.
Posted 4/3/2019 2:56 PM (GMT 0)
I will suggest this to his doctor, thanks
Posted 4/3/2019 2:57 PM (GMT 0)
I’d still try the double dose and increased frequency before moving on, it is the thing that will work fastest for him if it does work. Remicade did not work for me until I started double doses every 6 weeks.

Usually the progression is Remicade then a different anti-TNF like Simponi or Humira, then Entyvio, followed by Xeljanz.

Xeljanz doesn’t have that great of clinical statistics in treating UC and there is some concern that it should be a short term drug only. I wonder why your Son’s GI is pushing for it right after Remiciade?
Posted 4/3/2019 3:07 PM (GMT 0)
Yes I am a little perplexed by that also. He is on double dose but every 8 weeks, we could try Remicade infusion every 6 weeks n see if that changes anything.
Posted 4/3/2019 3:53 PM (GMT 0)
Hi yes i am happy with xeljanz but it's only been 11 weeks. I still have some symptoms but every week it improves a little bit. In the last fortnight i even started having days with one BM! Although it's usually 2-3 BMs. I did have a small change in the first week (i stopped having BMs in the afternoon or evening) but still had problems in the morning which made me initially doubt if it was working. Yes it's a new drug and there are some uncertainties regarding its safety profile, but it was the only option available to me (apart from surgery of course, which I have made peace with if it needs to happen) - so i had to try it.
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