In what order would you start biologic therapy?

This could be a useful thread for those that have failed the immunomodulators (6mp, imuran) and aren't sure what the next best step to take is. There are 4 'big guns' on the market today, as the thread title states what order would you start the medications assuming you could kind of manage flare symptoms with a temporary pred/uceris burst? And what's your rationale behind your order selection?

I am with the thinking along with UCmas. I gave Remicade a try and when that failed I really wasn't interested in trying any of the other biologics. Entyvio wasn't approved yet. They way my colon looked there was no saving it. That was just for me though. All the power to anyone willing to give them all a shot.

Uk protocol is infliximab (remicade) first and only if this fails are you offered Humira. I've had both ... First did nothing And second worked. Not sure why trying different ones equates to false hope (as I assume UCmas meant)?

I'd say it's a tie between remicade and humira for the first choice. If those fail then entvyio for second try. There's a lot of biologics, other than entvyio they're very, very similar. So, I can't recommend trying all 4, either they work or they don't for you.

I'm afraid insurance will dictate the answer. I have been on remicade since 2009. In 2014 I was having IV access issues and my GI suggested injections and told me to choose between humira and simponi. I did my homework and chose simponi and it was denied. My insurance required that I fail humira first which I had never been on. I ended up with neurological side effects from the humira and returned to remicade.

My answer depends on how severe the UC is at the time of biologic recommendation. If it's not well controlled, I would go straight to remicade. If it's somewhat manageable, I would try entyvio first and save remicade for later. One of the GI docs I work with told me that simponi is most similar to remicade.

My PPO never told me what to do. They approved whatever I asked for. I tried Simponi for starters. For some reason, I thought that would work well for me. I guess the ability to do it at home, coupled with the fact that I had read it's not as painful as Humira, made me think it was a great option. unfortunately I had zero response. Then I tried Remicade without a semblance of a response. We bumped that to a double dose and added MTX, still nothing... Then I moved on to Entyvio. I am not sure if entyvio was approved when I tried Simponi but it was VERY close to approval or just recently approved. I am not sure why i didn't go for that first. I guess I wanted something I could administer at home, plus I had seen the trial results for entyvio and it seemed less likely I would respond. I can't say I would do anything differently if I could go back. nothing worked for me so it's unlikely anything would have changed. I am happy I tried everything, if i hadn't, I would wonder if perhaps I could have saved my colon. In retrospect, I am much better off without it and without future worry and long-term drug use. I always knew this was the better option, I just couldn't bring myself to do it until I exhausted all the options,

notsosicklygirl says- I always knew this was the better option, I just couldn't bring myself to do it until I exhausted all the options,

I think that's the problem with most of us, we just don't want to accept it.