Posted 9/23/2016 11:25 AM (GMT 0)
Ulcerative colitis is best treated with multiple medications concurrently. I'd suggest adding immunomodulators (Imuran/azathioprine or 6mp) to the remicade as it'd likely produce the best results for you. Give uc the one-two-punch of two effective medications to control it better.
When you're talking biologics and ideal therapeutic range, you want to look at a Prometheus (or labcorp) test infliximab serum trough (minimum) concentration and antibody test. It's typically given 48 hours or less before your next infusion. You want to make sure there is enough remicade in your veins before the next infusion (therapeutic range) and that your immune system hasn't developed significant antibodies to remicade. In the event your minimum concentration is low and/or enough antibodies present, they increase your dose and/or infusion response to counter it.
What's your current dose and frequency? A typical dose is 5mgs per kilogram every 8 weeks. It can be increased to 10 mgs per kilogram every 4 weeks.
I'd add immunomodulators first and if that's not enough then you can consider switching to another biologic. If you have a lot of remicade antibodies then I'd switch to humira. If you don't have antibodies then you could consider entyvio. It's an entirely different biologic with a different mechanism of action, so there's hope it'll work better. Humira + remicade are very similar medications and therefore would likely work very similar to each other.