Next Steps?

Hello all - need some advice:
Long story short, diagnosed with left-sided UC in 2017. Go into remission with prednisone, rowasa, and apriso.
Had a long, happy remission on Apriso and twice weekly enemas. Was using the enemas daily for quite some time before tapering.

Began flaring in August 2023, got back into remission pretty quickly with the help of prednisone, hycort enemas (worked wonders), and switching to Lialda. All was well until ins. stopped covering brand name Lialda in January, so I switched to generic. By February I noticed a speck of blood here and there. I immediately upped to nightly rowasa. Despite my efforts, it's clear I'm flaring. I am on day 4 of adding hycort enemas that have taken care of a lot of the rectal symptoms, but my stool is loose and there's gurgling on the left side.

I wanted to blame the switch from brand name to generic for this flare, but I really can't be sure. GI seems to think that's not the issue - she's pushing for other meds.

My question is - is it worth it to try balsalazide at all?
My GI is pushing for Zeposia, but I am reluctant.
Other meds/suggestions are welcome.

Thank you all in advance

Thank you for your opinion. I agree it's wishful thinking on my end that the balsalazide will work any better. Probably grasping at straws here. I'm glad to hear Remicade got you into remission!

I'm on the highest dose of the generic Lialda. 4 pills daily.
I have an appt. next Friday with my GI. She'll probably order stool test at that time. I've just been in contact with the nurse as of right now. She wants me to start oral budesonide, but I have not started that yet.

Sorry you are here!! How bad are your symptoms right now? Like pooping more than 10x a day? Lots of blood? Pain? If they are worsening quickly, I wouldn’t fear starting a heavy duty drug. I think waiting just makes things worse (for me it did). My inflammation spread the whole time I took Lialda so I just didn’t respond much to mesalamines.

I honestly failed all the 5 ASA’s pretty fast and have been on some kind of biologic since 2011. My GI likes Zeposia and that will be my next drug if things go wrong with Rinvoq. It doesn’t have as many side effects as Rinvoq so I will probably end up on that one.

Thanks for your responses.
I'm due this August for my routine scope, so I really don't know the extent of the inflammation at this point. My GI may order one when I see her next week. I could try for prior-authorization, but my GI isn't going to push for it with insurance because she doesn't think that's the issue.

Bacon Girl - that's my issue, my symptoms are not terrible (touch wood!). When I started the cortenema, it was because I passed a fair amount of blood/mucus alone and had the gurgling/loose stool. I went into a panic that things were going to get much worse quickly. The cortenema has just about taken care of the bleeding within 3 days and my stool is more formed than two days ago. Making bathroom trips 2-3x, able to go about my day. Also, no stomach pains right now. I have not started the oral budesonide either.
My flare up in August was much worse, but I think I waited a bit too long to try to clear things up on my own with the nightly enemas.

momto2boys - that's helpful information, thank you. Do you think adding the imuran has made a difference with the Colazal? I can see the increase in pills being a bit of a nuisance. I want to believe the switch to the generic had something to do with my current issues, but I'll have to convince my GI of that.


Thank you again! I guess I feel like I can't decide whether my symptoms/response to medication at this point warrants me trying something else or not.

Post Edited (Lanah) : 4/17/2024 4:51:04 AM (GMT-8)

Hi Bacon Girl - My dr's staff can fight to get the Lialda, but without my GI on board, I don't see that happening.
Through goodrx and other coupons, I haven't seen cheaper than roughly $200 for 30 days. That's just not practical for long term.

Thanks for your input about the imuran. I know there's a lot of differing opinions regarding side effects/safety of meds, but in your opinion - do you think imuran is a better next step than zeposia? Thoughts on velsipity as well?

Agree with BG that you should get info on available options, Lanah, rather than rush to Zeposia. (Wasn't that originally developed to treat multiple sclerosis?) The usual progression in UC meds has been from 5-ASAs to Imuran (azathioprine) or 6-MP, at first-- which Momto2 has been doing. *** It may be that your gastro has a research interest in Zeposia that colors the attitude toward changing your med now. RE out-of-pocket Rx med costs: $200/mo. is low for brandname considering what the market-rate demands in general for IBD drugs. / Old Hat (40+ yrs with left-sided UC; in remission taking Colazal)