At the dark crossroads, considering humira, etc need advice

so Im back down a few pegs after switching to eggs over gluten free (gas inducing) bread for breakfast, went through a major bad spell, had to go to ER, etc. Needless to say this is not how I was hoping to spend (another) summer.

I guess Im confused between biologics and imuno suppressants, though I think that they all suppress the immune system... I know someone who just got on humira for AS, and says it helped right away. The side effect list is of course a major put off, but living like this is too much.

What Im wondering is, is there a "safer" one of these to try, or all they all a major roll of the dice?

Hypothetically, say I were an extreme athlete, which would be "most recommended?" as if there were a really good answer to that… I just want to feel functional again and quit pissing my life away. Im normally strong and physical, and I don't really want to compromise that, although I am nothing but compromised at the moment, well, for the past three years of moments that is.

Are there incidents of these drugs really doing the trick with no strings attached? Not like I expect to be so lucky, just wondering.

Also, is simponi supposed to be somehow better, since its newer? Thanks for any tidbits.

Remicade over humira? Any thoughts there??

:/

Freddyj, There are two basic approaches to treating uc. The first is the meslamine-based drugs (asacol, lailda, apriso, rowasa, meslamine suppository, etc) are anti-inflammatory medications. The second approach is everything else, which targets the immune system in some way: biologics (remicade, humira, simponi, entyvio/vedolizumab), immunosurpressive meds (6mp, imuran, aza), and steroids (prednisone, endocort, uceris, etc.).

Immunosuppressive drugs (6mp, imuran, aza) reduce your white blood cell count. White blood cells are the attack-dog of the immune system. Less white blood cells in your system, less uc inflammation can be caused. The side effects of these drugs are pretty statically rare. The scariest is lymphoma which as 4 in 10,000 (or 0.004%) odds of effecting you. More common is an increased odds of contracting an infection, and it becoming severe if not treated. These are things like UTI's, bronchitis, etc. Basically, see your dr sooner rather than later if you are suspect you might have one (you don't have to be a germaphobe or anything).

Biologics interfere with the immune systems natural process of signalling the need for an attack on body tissue, responding to attack signal, and the attack itself. The TNF-alpha medications are pretty similar: remicade, simponi, and humira. Of those remicade has been around the longest, and is often considered to be the most effective of the group (60% of uc patients see improvements after taking remicade). Second most effective is simponi. Humira is last. All of these tnf-alpha blocking meds carry a lymphoma and increased risk of infection warning on them. Odds of lymphoma 6 in 10,000 (or 0.006%) when used at the same time as an Immunosuppressive drug which is often the case/recommendation.

Entyvio/vedolizumab is the newest of the biologics, and presumably has the safest profile of them. Entyvio targets gut-specific tissue, and leaves the rest of your body alone. As such, it does not carry the lymphoma risk that the above meds do. It does not include the increased risk of infections as the above meds do. It's new to the market, not all insurances cover it yet, not all GI's prescribe it yet. It is certainly something that looks promising. You likely, need to have failed another biologic medication before you can get it. Price unknown at this point.

Thanks, thats helpful everyone

The theory is that Entyvio has the best safety profile of any of these drugs because it is the most targeted. However, since the drug is brand new there is only data on the 3000 people who have taken the drug in clinical trials, and obviously no long-term data. While Remicade/Humira/Simponi can cause more side effects, study after study is debunking the whole cancer/lymphoma risk. The latest study came out last week:
http://health.usnews.com/health-news/articles/2014/06/18/popular-crohns-colitis-drugs-not-linked-to-short-term-cancer-risk-study

I'd start with one of the anti-TNF's, probably Remicade. They're much easier to tolerate than the immunosuppressants. Plus, the immunosuppressants take months to become effective (some data shows Entyvio does too) while some people see improvement within days on an anti-TNF.

Yes, everything other than the meslamine meds are a form of immunosuppression. Remicade included. It's not like your immune system is shut off or anything, it is just knocked down a couple pegs.

They call Remicade and the other anti-TNF's immunomodulators because they do not suppress the entire immune system, rather they suppress one componen - TNF alpha. They call Imuran, 6-MP, and methotrexate immunosuppressants because they more generally suppress the immune system. Yes, I know, this is all semantics because technically they all suppress the immune system.

your view is very nice btw.