Entyvio Remission Help-Hydrocortisone enemas.

Hello all. Long time lurker and first time poster. Left-sided colitis Dx’ed 2017. I have been on Entyvio for about 10 months. I was doing great until about June. I quickly noticed that the entyvio was wearing off about halfway through (8 week intervals). We switched to 4 week intervals, and I just had my 4th dose at 4 week intervals. Doing okay and nowhere near where I was last year (20+ bloody movements a day and hospitalization for IV steroids), but I am definitely not 100%. I am currently through 1 week of hydrocortisone enemas. about 1-3 movements a day, all in AM. And formed for the most part. Some mucous and discomfort, but definitely no watery and bloody diarrhea. I always flare this time of year.

here is my question: Is it possible to do a monthlong hydrocortisone enema course followed by an enema taper? To get me through my yearly flare period and back on track to remission? I’d hate to switch biologics even though I feel it is still working to an extent. It seems foolish to switch when it is still having a positive impact. I would rather leave well enough alone than completely abandoning a biologic after a year.

Also, I have no discomfort retaining the enemas at all. It is easy and I can hold them through night. So that tells me the rectal inflammation is not the worst.

As a side note: I am a 2nd year medical student, and I try to stay up on the research. It seems there are many exciting biologics AND small molecules with new Mechanisms of Action in the pipeline within the next 5 years! It seems the FDA has tightened the standards on IBD trials to include a ‘histologic remission’ metric, so companies are researching agents that do not suppress the immune system. The new agents would actually attempt to repair the epithelial integrity. Just wanted to add that last part to give some hope! Help is on the way fairly soon, and I am excited for longer lasting and more efficacious agents. Check out obefazimod (ABX464) as an example.

Have you tried uceris foam? I know the pill version doesn’t have quite the side effects, etc, as prednisone — not sure about the foam but it might be something to check into.

Thanks for the info on new drugs in the works!

I am allergic to sulfites and sometimes the sulfite free formulation Rowasa goes out of stock for months on end. When that happens and I am flaring my only option is the steroid enema. I have used them for as long as 4 months, and yes, I have to taper off of them but they work well and for me, they also work very quickly. I don't think a month is a long time to be on them at all.
My doctor said that before Rowasa the only option was the steroid enema and all things considered, the enema has fewer side effects than oral prednisone.

Sara,

I tried Rowasa in the past, and I never felt it did too much. I did them for a few weeks and I didn’t notice near the improvement I saw on hydrocortisone enemas in just a few days.

My plan is to alternate hydrocortisone enema with mesalamine enema when I taper. Maybe the steroid enema will jumpstart the mesalamine. Idk