HealingWell
Search Close Search
☰

Biologics to treat a flare?

Support Forums
>
Ulcerative Colitis
✚ New Topic ✚ Reply
❬ ❬ Previous Thread |Next Thread ❭ ❭
Posted 6/26/2016 12:16 AM (GMT 0)
Has anyone used a biologic to treat a flare and get into remission and then were able to continue on 5ASAs for maintenance?

This flare I have is very stubborn and I really don't want to go on pred, but I'm not sure I want to be on biologics all the time because I already seem to get sick a lot. I am certain this flare started because I was expelling too many whole Asacol tablets so I wasn't getting enough meds. When I stopped drinking nopal too (because of business trips) I think I tipped into a flare. I just switched to Lialda on Tuesday so I want to give it a chance to work. Just don't know if the Uceris is working to give the Lialda time to take over. It took nopal a long time to get me into remission before and I wasn't flaring as badly as I am now.

Yesterday was so bad that I called the on call dr at my GIs office last night and asked if he thought I should go to the ER, Urgent Care, or just try to give it more time. I don't know this dr and he kept saying losing a lot of blood is really bad (duh!). Then he said that if I still felt bad this AM I should go to the ER because Urgent Care couldn't treat me. Well I spent the day in the ER -- will probably cost me a ton of $$ -- and all they did was some lab work (blood work and a c-diff test), gave me a bag of fluids, some potassium pills because my levels were low and a shot of decadron -- things I'm sure I could have had done at Urgent Care for a lot less money. I do feel better from the decadron though! I know that's only temporary and I have to follow-up with the GI on Monday. I have to get a new GI because the one I had retired last year and since I was in remission I have just been getting my scripts from the Physican Assistant. I know I do NOT want the guy I talked with last night! There are other GIs in the practice and I know which one I would like so hopefully that won't be a problem.

I ramble! What do you think about my original question? Biologics to get to remission then Lialda for maintenance? Possible or once on a biologic always on a biologic? Basically can a biologic be used instead of pred just to induce remission? Pred make me so moody I really don't want to go on it again at high doses unless there is no other option
Posted 6/26/2016 1:14 AM (GMT 0)
To answer your question, yes, it can be. Infliximab (Remicade) has been used in the UK for treating acute flare-ups of UC and probably still is in some hospitals. That said, I don't think it's a great idea. If your UC is severe enough to warrant a biologic in the first place, it's probably better to stay on it. Stopping and starting biologics also increases the risk of antibody formation.

My previous hospital would only offer Remicade for 3 doses, but it was a crap hospital. I was refused even those 3 doses on the grounds it wouldn't do anything and they were worried about making the narrowing worse (even though I was told previously I didn't have a stricture). Wish I could remember the exact words now, but I was gobsmacked even at the time - this was about 6 or 7 years ago.
Posted 6/26/2016 11:17 AM (GMT 0)
I had thought about the antibody problem, but wasn't sure if it would that would happen if you only did it for one flare. I just want to avoid pred if possible this time to give Lialda a chance. If Lialda fails I will have to go on biologics full time and am ok with that if that's what it takes to stay in remission and I'll just have to keep my fingers crossed that all the bugs I chronically pick up now don't get worse.

All that said -- I can't believe how well that shot of decadron works! I slept through the night. No pain at all now, formed but soft actual stool and only very faint blood this AM. I know the shot is only temporary but I am loving today!

How are you feeling, NCOT? Is the 6 MP kicking in yet?
Posted 6/26/2016 5:42 PM (GMT 0)
It could happen if it you use Remicade only the once, but to be fair it can happen anyway even if you never miss a shot of Remicade - antibody formation is a real problem with the biologics. There have been people who took Remicade, stopped it for a while for whatever reason, and then successfully resumed it at a later date. Unfortunately, like everything else with this disease, it's hit and miss and you can't tell in advance who will be the 'lucky' ones.

If it's any consolation, I was on Remicade and varying doses of pred for a whole year and only caught one cold the whole time, which didn't last any longer than usual. I actually had a much worse time of this winter, even though I wasn't on any meds (hadn't started the 6MP yet) - a cold which seemed to go on forever, cold sore after cold sore, an eye infection, etc. There's no rhyme or reason with these things :-/

Had to google decadron - glad it helped! Steroids were a miracle temporary cure for me as well.

So far, no sign of it ;_; Been on 50mg for exactly two months now, so it's relatively early days still. I'll be keeping a close eye on my symptoms over the next month.
Posted 6/26/2016 7:39 PM (GMT 0)
Hope the 6mp starts helping soon for you. From what I have read between months 2-3 is where the magic begins. To me all meds are a form of magic ... just magic with science behind it :)

I saw an intact Uceris pill went I had a 2nd BM this AM (so far that's all!!!). That's likely why I am not getting any benefit from the Uceris -- they aren't dissolving! I must have acidy poop! I sent a message to my dr office to get a script for Entocort -- I know that releases higher in the colon, but at least it releases so I should get some benefit from it and I can't get any benefit from Uceris at all if the pills aren't dissolving.
Posted 6/26/2016 8:08 PM (GMT 0)
I wish the magic would hurry up and get started in my case! >.>

That's strange about the Uceris. I was on a course of Entocort and it worked quite well for me. Never saw any pills in the toilet bowel either, despite no longer having a colon. The only annoying thing about it is that, like all steroids, it stops working as soon as you come off it...

Anyway, I hope Entocort helps you and that the Lialda kicks in as well.
Posted 6/26/2016 8:32 PM (GMT 0)
Couldn't you stay on it until the 6MP kicks in?
Posted 6/26/2016 9:00 PM (GMT 0)
Well, I wanted to see if the 6MP worked without the Entocort confusing things... :-/

Wish I had stayed on it on a few weeks longer now, particularly as I had extra pills anyway. But I might as well wait now to see if the 6MP does kick in.
Posted 6/26/2016 9:23 PM (GMT 0)
I'd be scared to stop and give up the option for the future, but i don't think it's 100% that it works that way for everyone. On the other hand, i saved it for a treatment hwen I was 100% against taking steroids and i was a non-responder. It was so upsetting...
Posted 6/26/2016 9:54 PM (GMT 0)
Remicade didn't work for me and I had never taken it before either.

It did have an initial effect, but only on my inflammatory markers - not my symptoms. Unfortunately I never had an antibody test so I'm not sure if I built up resistance almost immediately or whether my disease was just too severe for Remicade to deal with by that point. But I took Humira and that had even less of an effect than Remicade. I think it was the latter. There's a lot to be said for going on a biologic relatively early rather than waiting until you are on the brink of surgery. Studies have shown that IBD has a more favourable prognosis if you hit it hard early on with biologics.
Posted 6/27/2016 2:54 PM (GMT 0)
I always wondered about this too. But have not heard any one doing it. I hear about top down treatment approach and wonder how it works. Do they treat with biologics and then go down on 5-ASA once you are in flare??

I think its worth trying. Now so many biologics in market, if you develop antibody for one, you can go on different one.

I think there was someone on forum who stopped Remicade because of pain issue and I believe he is doing fine with UC symptoms. Not sure how he is doing now.

Post Edited (PamSmith) : 6/27/2016 8:57:38 AM (GMT-6)

Posted 6/27/2016 3:46 PM (GMT 0)
Essentially you're trying to use biologics as prednisone (an emergency rescue only) and that's not what they're prescribed for. I don't think they're many cases that biologics are used for a month or two and then discontinued (except for nonresponders). And as such, you might have trouble gaining insurance company approval the first time, or especially a second time if you discontinue the first.

If a biologic works then stick with it. They're both an initial emergency response and maintenance treatment.

Antibody development isn't a hundred percent understood. Generally, your immune system attempts to make antibodies to anything foreign that enters your veins as a form of self defense. That immune attempt appears to be strongest upon first exposure to something new. Biologics are proteins that dock with other proteins your body naturally creates, so they look like baddies.

If you were to take biologics for a month and discontinue then you'd likely be at highest risk for antibodies. There's no guarantee they'd form, and no known odds, but it'd be a risk.
Posted 6/27/2016 7:53 PM (GMT 0)
Well, my body decided it didn't want to wait for the biologic option anyway. The shot wore off about 3 AM. I called the GIs office and had a long talk with the PA I normally see -- smart woman who should really be a dr. I am on 8 weeks of pred for now (40 mg for 2 weeks and then drop 5 mg/wk) and am going to go ahead with the testing needed for biologics so in case I decide to go on them all that will already be done. I couldn't get an appt with her til Friday but she went ahead and started me on the pred since the ER did the c-diff test on Sat. She said if I am doing better by then I can cancel that appt and I'll see her on the one I already had scheduled for Aug and we'll discuss the path forward. I'll have plenty of time to see if I start seeing Lialda pills like I did the Asacol. If I do then there is no real decision to be made -- I will be starting on biologics in August.

Well at least I have a plan now. Hating being on pred, but who knows? Maybe it won't make me carzy this time ~fingers crossed~
✚ New Topic ✚ Reply