HealingWell
Search Close Search
☰

bleeding gets worse after dosing of MTX and Humira??

Support Forums
>
Ulcerative Colitis
✚ New Topic ✚ Reply
❬ ❬ Previous Thread |Next Thread ❭ ❭
Posted 6/27/2017 3:22 PM (GMT 0)
I'm really trying not to get discouraged, but I'm at a loss. I've been on MTX and Humira together for almost 6 weeks. I take 15mg of MTX every Saturday night and Humira on Sunday night. My Humira doses have varied as my doc is trying to increase my levels, but the last two Sundays I've taken 80 mg (2 pens). I've noticed my bleeding returns/increases during the day on Sunday (after MTX, before Humira), and continues to increase over the next few days. And of course with more blood comes more urgency. By Thursday, it will start to decrease continually until my next dose.

The biologics nurse at my GI's office feels this could be attributable to the fact that I don't yet have therapeutic levels of medication in my system, and the increased bleeding is not an effect of the medications, but instead an indication that my body NEEDS the medication around the time I'm taking it. So essentially, my trough levels are too low. Humira trough test on June 12 showed levels at 4.6, which is why doc increased my last 2 weeks of Humira to 80 mg.

Thoughts??
Posted 6/27/2017 4:34 PM (GMT 0)
Has switching to remicade been discussed? Subcutaneous (just below the skin) injected biologics as a generalization have less dosing options, have more inconsistent body absorption, and need more frequent administration than IV-based medications like Remicade does. I'm assuming that you do have a response from Humira and are just clearing it from your system to fast to have a sufficient concentration of humira in your body to maintain a ideal therapeutic (healing) affect.
Posted 6/27/2017 5:01 PM (GMT 0)
iPoop--Remicade and Entyvio were both offered as treatment options (by my previous GI) before I started Humira in 12/2015. I chose Humira out of the 3 since I could administer at home. My current GI felt that I needed to give Humira a "last ditch effort" before changing to something else. I see you're on Remicade and Lialda for proctosigmoiditis. I have the same diagnosis; doc discontinued my Lialda, but didn't replace it with another oral drug. When I questioned him about that, he explained his feeling that oral drugs don't necessarily help this diagnosis as our problem is basically at the end of the line, therefore oral drugs don't "get there". I didn't argue much further since I personally suspected the Lialda was doing very little for me anyway. Have you had any experience with that??
Posted 6/27/2017 5:21 PM (GMT 0)
I have zero doubt that oral mesalamine can consistently reach the sigmoid colon for proctosigmoiditis patients, and that enemas and oral mesalamine are great treatments for it. I do definitely doubt that oral mesalamine consistently and effectively treats the rectum (therefore suppository and enemas are best for it).

If you're already on MTX and Humira, then an oral mesalamine might help just a little for any remaining mild-level inflammation (and that's why I am on Lialda and Rowasa due to some lingering, minor inflammation) as there is a cumulative effect of having multiple meds used concurrently. Mesalamine is like a squirt gun and Humira is like a firehose, while both can put out a fire there is an order of magnitude difference in the strength of those treatments.

Actually doing the rowasa twice daily at the moment, doctors orders, and it seems to be helping improve things over the last 3 days. So, I wouldn't completely write off mesalamines for even patients on stronger classes of meds; they can help to a degree at least.
Posted 6/28/2017 3:33 PM (GMT 0)
Thanks for the feedback, iPoop. Bleeding is less today, gas is increased, and stool is soft formed, but I'm soooo exhausted. I've been fortunate not to have pain or spasms, however that luck seems to have run out the last week or so. The pain isn't constant or unmanageable, and I'm guessing it's caused by what I think are spasms on my left side and rectum. Waiting for my GI's office to call me back. Going to ask about restarting Lialda. My previous GI prescribed Librax, but I never took it as I was feeling pretty good at the time he gave it to me. Wondering if that would help at all...
✚ New Topic ✚ Reply