Switch from Humira down to 6MP?

Hi all,

I'm posting this hoping for some quick responses before my GI appointment tomorrow. I was diagnosed with UC pancolitis in January of 2010. I did fine on Lialda for 6 months until I had a major flare in July of 2010. After not responding to large amounts of Prednisode and after a sigmoidoscope, my GI classified it as moderate to severe pancolitis. Since I wasn't responding to Prednisone, he suggested I start a biologic right away. He thought Humira was a better drug than Remicade in my case because I could start it sooner and it might start working quicker.

The Humira has been working great since August of 2010, in conjunction with one Lialda per day. At the time of this major flare, I was uninsured due to self-employment. Because of this, I was able to receive Humira for free from Abbott. Since then, I have been able to go back on my parents' insurance because of the healthcare reform.

However, the new insurance is adamantly denying coverage for Humira and Abbott won't provide free coverage because I am slightly over their income cap. My doctor has written several letters trying to appeal the denial, but the insurance company suggests I go on Remicade.

I don't like this option because Humira has been working great and I hesitate to switch just because of insurance coverage.

But also, I always wonder if my GI and I switched to Humira too quickly. Yes, I was in a BAD flare and was not responding at all to high doses of Prednisone. But I wonder if the doctor would have tried 6MP or Azathioprine before Humira if I didn't desperately need quick results.

So with all of this in mind, I have some questions I hope some of you can answer. I have a GI appointment tomorrow afternoon (Monday, August 8th) and hope to discuss the following with him:

1) Do you have any suggestions to appeal to my insurance company to stay on Humira rather than switching to Remicade or 6MP?

2) If it were you and you were responding well to Humira, would you consider "downgrading" to 6MP if you originally "skipped" that step in the medicine chain?

3) Once again, if it were you, would you feel more comfortable about the side effects of 6MP vs biologics?

4) If I stop Humira and need to go back on it or Remicade in the future, does it generally work as well the second time around?

5) about how long should I expect it to take for 6MP to start working in my system.

6) I'm not having many complications at the moment, besides urgent morning BMs... do you think now would be a good time to try switching drugs?

7) If I switch to 6MP, do you suggest a grace period to stay on both Humira and 6MP... and when/how should I ween off Humira?

8) After potentially starting 6MP, is it common to stay in a 5ASA (Lialda in my case)?

Thanks everyone! Even though I don't post often at the moment, I still read HW every couple of nights!