1 month break from Remicade

benzo,

Welcome to the forum.

I was taking Remicade every 8 weeks, I had emergency surgery due to a structure. I was late by almost 5 weeks. I did not have a reaction during that infusion, I was premedicated, and I was watched very closely during the infusion. My Remicade trough level had dropped to 1.6 just prior to the first infusion following surgery. We changed the dosage to 10 at every 6 weeks. It took 2 more infusions to get me back under some semblence of control. (I have Crohns) The fourth infusion after surgery finally brought me relief. I had to continue at the highest dosage for a year. We have just adjusted my dosage to 7.5 every 6 weeks. The plan is to hopefully get it back down to 5 every 6 weeks and then to go every 8.

Sidenote...when I was taking Remicade prior to the surgery I also took methotrexate. They took me off the methotrexate 2 weeks before surgery. I had the Remicade infusion about 8 weeks later and they tested for antibodies. I had built antibodies so I returned to the methotrexate and the antibody level dropped from 9.6 back down to 0. That doesn't usually happen ...usually your level may lower alittle or stabilize but it usually does not fall down to zero.

In my opinion you should have your levels checked to help regulate the amount and timeframe of your Remicade treatments. In June I will have been on Remicade for 3 years. We use the trough level/antibody level answerisx test to help us.

Good luck and hang in there!

Clo

benzofromrenzo said...
Has anyone experienced a break like this, and if so, did they have flare ups during the break? Also, how long after the next dose did flare ups go away.

With remicade you want to maintain an ideal therapeutic (healing) level of remicade within your system. Skipping 4-weeks has undoubtedly dropped you out of therapeutic range and caused your flare. This infusion at the normal dose may not put you back into therapeutic range. You might need a stronger dosage (10mgs per kilogram instead of 5mgs/kg) and/or more frequent dosages (4 week or 6 week interval, instead of 8 weeks) to get your remicade levels back up to the needed amount. Certainly, discuss this with your gasteroenteroligist.

You can ask for a "infliximab serum trough levels and anti-infliximab antibody levels" blood test to help with the dosing.

Prometheus labs originated the test and still offers it for a big price:
/www.prometheuslabs.com/Resources/Anser-IFX/Anser_IFX_Product_Detail.pdf

It's also generic and available from Labcorp and a number of other labs:
/www.labcorp.com/test-menu/29496/infliximab-concentration-and-anti-infliximab-antibody

Certainly add standard flare protocol in addition to getting your remicade infusion. You might need to temporarily add new meds (like uceris/prednisone) and/or up your dosage of other medications. All depends how severe your symptoms are. The old adage applies that it takes more medications to achieve a remission than to sustain a remission. You've lost yours and might need more meds and stronger dosages to get back into a remission.