After Humira Stops Working

Hey All,

Had a bad flare for about a year up until April was finally put on Humira and after about a week or two it really started working for about 4 months. Went into remission and tapered Prednisone to about 10mg and then the symptoms all started returning, slowly but surely. Had a colonoscopy and it looks like they found "active disease" up to about 25cm (which is 15cm less than last time).

My question is if anyone was in a similar situation where Humira worked and then stopped working for whatever reason. What is the next step? I'm taking Lialda, Imuran, and Prednisone as well. You'd think taking 4 medications would stop this thing!

Will they increase my Humira dosage? I'm on one injection / week.
Change to drug in same class of biologics?
Change to drug in different class of biologics?

Anyone been in this situation? Thanks
David

How long were you on pred before you started the Humira? And what dose of pred before you started it?

Your symptoms may have improved when you started Humira, but you don't know whether your inflammation actually got better and then subsequently got worse again.

When you start a drug like Humira, you should give it every chance to work before switching. You should start by having blood tests to check your levels of the drug and to check for antibodies. Then, depending on results, you might increase your frequency and/or dosing.

Only after giving Humira all the chance you can should you switch to another med.

"Had a colonoscopy and it looks like they found "active disease" up to about 25cm (which is 15cm less than last time). " Was the inflammation mild, moderate or severe? I'd make big biologics changes on moderate or severe inflammation scenarios. If you have only mild inflammation then consider reintroducing rowasa enemas, tacrolimus suppositories, steroid enemas/foams etc.

I'd ask for a humira/adalimumab concentration and antibodies test, and decide based on the results of it. The blood test is given before your next Humira injection, when your concentration should be at its minimum. Prometheus labs invented the test and still offers it for a premium, they call it: Anser ADA. /www.anserifx.com/

It's also available as a generic from Labcorp and many other labs across the country for a lot less. /www.labcorp.com/test-menu/18766/adalimumab-concentration-and-anti-adalimumab-antibody--serial-monitor/

I'd say you're just about maxed out on your Humira dosage at weekly.

What can the test tell you?

1.) If you have high antibodies and low concentration of humira then going to another tnf-alpha-blocker makes a whole lot of sense: Simponi or Remicade.

2.) If you have no antibodies and high concentrations of humira then you've likely failed humira and all tnf-alpha-blockers. In this case then I'd consider entyvio or xeljanz.

3.) If you have no antibodies and low concentration humira then I'd consider Remicade which has a lot more dose variability. You're likely max dosed on humira, but Remicade can go higher (up to 10mgs per kilogram every 4 weeks).

I was on Humira for about 9 months and at first it seemed to be working but it was not long before the effectiveness started to fade .
My GI then switched me to Entyvio which is working great for me and in reflection far better than Humira ever worked for my situation.