Is there another treatment option before Entyvio?

I was recently diagnosed with ulcerative colitis in September of this year. I am very new to all of this so I have a lot of questions. My GI doctor put me on Lialda and Prednisone to begin with. After being on this for a few weeks my symptoms (bleeding, diarrhea, cramping) got better. When I started to decrease my Prednisone dosage to get off of it my symptoms all came back, honestly worse than before. My doctor said that I had relapsed and that Lialda didn't seem to work for me and my condition. His next step for me is to start receiving Entyvio infusions. This seems to be a little much to me. Is there anything else to try before having to receive infusions??? He said I would get the infusions for a year and then we would take another look with another colonoscopy to see what it looked like then. Im just wondering if there's anything else that should be tried before Entyvio? Thanks in advance.

Hi and welcome to the forum, but sorry you have to deal with Ulcerative Colitis like we do.

There are three classes of ulcerative colitis medications.

First is anti-inflammatory mesalamine-based drugs (your lialda) and it's recommended that a patient take 4.8 grams orally (4 lialda tabs) and 4 grams rectally (a rowasa enema) for 3 weeks to see improvement. I didn't see the rowasa mentioned, they work well.

The 2nd class of ulcerative colitis medications is added which is immunomodulators (imuran/azathioprine or 6mp/mercaptopurine). These are slow working medications that take 3 months to work and require routine blood monitoring. I didn't see these mentioned.

The 3rd class of ulcerative colitis medications are biologics and examples are entyvio, remicade, humira, and simponi. So, yes there are more choices. These medications are generally a lot faster working, in 6 weeks or less and don't require blood monitoring.

Sometimes the second class of medications is skipped in severe cases where time is of the essence (expecially in pancolitis cases involving the whole large intestine and in pediatric cases). Above me points to discuss with your doctor, as there are a lot of options available.

It is a bit strange your GI is jumping straight onto Entyvio. Most people try Remicade or Humira first; Entyvio is a much newer, and more expensive, drug.

Rectal meds are decent for reaching the rectum and left-sided colon, which is where UC typically tends to occur. More advanced cases of UC affect the entire colon (also known as pancolitis). Oral and rectal mesalazine (Asacol, Lialda, Pentasa, Rowasa, etc.) cover the entire colon between them, but can only treat mild to moderate inflammation.

I'm wondering if you have pancolitis or severe inflammation, which is why your GI is rushing to put you on Entyvio.

It's more common these days for immunemodulators (6MP or azathioprine) to be added alongside a biologic (Remicade, Humira, Simponi, Entyvio, etc.), but they used to be used as sole medications in the past and sometimes still are. If your disease isn't too severe, it may be worth trying another brand of mesalazine and adding in a rectal version too.