Remicade bridge to J-pouch

If you've failed at least 2-classes of biologics then a colorectal surgery is something to consider.

If you haven't then do not consider it. I understand we all get frustrated and it's easy to throw your hands up in the air and say F this disease, check please, I am outta here and go for a surgery. However, a remission through biologics is preferable over surgery.

What are the classes of biologics?

There's the block of similar tnf-alpha-blockers (pick one): remicade/humira/simponi.

There's Entyvio, Stelara, and Xeljanz which are all different from each other and the aforementioned tnf's.

I'm 7+ years on remicade most of which has been in a remission. So them failing in quick succession is not a certainty. Some aggressive cases will fail multiple biologicals and land in surgery (about 25% of us) but the majority do not.

That's kind of shocking. They wouldn't let you go up to 50 mg but they're putting you on IV steroids? Strange and it's only been a week. I personally hate IV steroids. They make me an emotional wreck after just a day or two. Xeljanz works way faster than Remicade. Stelara and Humira are both supposed to work within about 8 weeks, so pretty similar to Remicade. Just try to take it one step at a time. I understand where you're coming from completely though. I really hope the IV steroids work for you. You've been sick quite a while.

Lol, I'm sure you'll be fine. I was also on a lot of Dilaudid that time, haha, but I think it was definitely the steroids. I had to ask for xanax. Are they admitting you or this done outpatient? I don't think insurance will even cover surgery until you've tried several biologics, but I've never actually checked into that. Just something that was said on this forum. Good luck! The thing with the jpouch is you're still going to poop on average 6-10 times every day, so that was a bummer for me when I learned that, but apparently they are not painful BMs so maybe it's not a big deal.

>iPoop - why specifically is remission via bio preferable?

A remission is always preferable over a surgery. Surgery is the closest thing we have to a cure but it is not a bonifide, you've never had UC and back to your normal life before UC diagnosis kinda thing. And I do think there is some misconception of that persisting in some. If a remission is not attainable for you through medicinal, then a colorectal surgery is a good solution and quality of life.

Let's compare it a bit. A remission via meds gives me 1-2 non-urgent, solid bms a day. If I had a j-pouch, then I might poop 4-6 times without urgency about evenly spaced out over 24-hours, due to the shortened digestive tract. Surgery has small risks of things like reduction in fertility in males/females, low risk crohnic-pouchitis (requiring medications on an ongoing maintenance basis), abscesses/infections at surgery site, nocturnal fecal incontinence, adhesions causing chronic pain, etc. Some of those are more of a concern during the adaptation-period and recovery after the surgery but in a smaller pool they do persist as ongoing challenges. Dehydration can be an issue post-surgery as well.

IPoop you mentioned in previous posts that you’ve had some small flares while on Remi. What did you do about those? I have no mesalamine options and steroids don’t seem to work. So just move up the next infusion?

Hi i didn't read the whole thread.

First off, XELJANZ IS NOT A BIOLOGIC. Immunomodulator yes, but not a monoclonal antibody. Hence no need for infusions or injections, and no risk of antibody formation.
It's tablets and many people respond within 3-7 days.
If you can, I would give that a try before surgery.
Its the only drug that put me in a full remission and I tried nearly all of them (everything except stelara).

Good luck

Yes it was licensed to treat UC in 2018, although clinical trials were running several years prior. There's one lady on here who's husband has been in full remission for 3+ years using xeljanz.

Thanks iPoop you’re the best! I mean that!

You don't want to try any other meds before surgery? Seems very rushed. I'm glad you only had 4 BMs.

Xeljanz only takes a few days to work.

Remicade can work very quickly in some cases and it is used as rescue therapy.

Ask about tacrolimus as a bridge to remicade. I know some docs use that with Entyvio to deal with the slow response time...so Entyvio could still be an option as well with tacrolimus.

sevodreams said...
Right, but I may not have the luxury of time to see if remicade works at all then try another med. it all depends on how much the IV steroids contain the current situation and if the oral steroids continue to do so afterwards. Obviously I don’t want to be on steroids long term, but since the oral stuff wasn’t doing much before that might be a moot point. It’s not like I can stay in the hospital on IV steroids for months until I find which med works for me. Is it possible that the IV steroids will jump start things so that the oral steroids are more effective than before?

As stated in my post right before yours, remicade can work very quickly and is used as rescue therapy in steroid refractory patients.

I would also look into Tacrolimus as it is HIGHLY effective for short term use and can provide a bridge to other therapies.