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Asacol Maintenance dose and Jak Inhibitor treatment?

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Ulcerative Colitis
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Posted 7/11/2019 2:42 PM (GMT 0)
Hi everyone.... I am currently on 4 x 800mg Asacol tablets per day and 1 x Pentasa 1g suppository at night. This dosage seems to keep my UC/Proctitis under control and has done for a couple of years. However, I am now concerned that this dosage is too high for me to take indefinitely.
My GI would like me to get onto more modern medication. He says there is a new ORAL Jak Inhibitor drug out now. He says low grade inflammation over years (in my case 30 years) increases the risk of cancer.
However, in order to go on this new drug I would have to induce a flare-up i.e. not take my medication in order to qualify for the new oral Jak inhibitor. This scares me senseless as I know all to well how many years it takes to heal again.
Any advice / suggestions would be greatly appreciated. x
Posted 7/11/2019 5:57 PM (GMT 0)
There's nothing wrong with taking 3.2 grams a day of oral pentasa and 1 gram of pentasa suppository a day for life. It is a perfectly safe maintenance medication for UC. Some are able to go down to 2.4 grams a day of oral and get rid of the suppository once confirmed in a long term, sustained remission for his/her maintenance dosage.

However, you do not sound well maintained if you are saying you have had inflammation for 30-years, so I would not suggest dropping your dosage at all, On the contrary, you might want to consider increasing your dosage to 4.8 grams oral a day (ask your doctor about that) and also a salofalk/pentasa 4.0 gram retention enema instead of the suppository.

I would not induce a flare to try a different medication, sounds stupid.
Posted 7/11/2019 7:50 PM (GMT 0)
I agree with iPoop. Why rock the boat? Do you have inflammation at all? Have you been scoped recently? If you're in remission, you don't have low-grade inflammation. I would get a scope to assess whether there is inflammation. If there is, then you can add the other med.
Posted 7/11/2019 10:29 PM (GMT 0)
If you are in remission on the meds you are on then stay on them. You are on the mildest of the meds for this disease and can stay on them long term.

I would really question a doctor who wants you to purposely go into a flare in order to try a more "modern" medication (and insurance may or may not even approve it if you haven't tried some other older types of meds). Is the medication Xeljanz? That was recently approved for UC and based on conversations I have had with a couple docs I suspect that the drug reps are really pushing it as a wonder drug. For some it is. But do some research and you will find it doesn't work for everyone.

If it ain't broke don't fix it smile
Posted 7/12/2019 12:01 AM (GMT 0)
couldn't agree more with what CC said -
Posted 7/12/2019 11:55 AM (GMT 0)
I do not believe xeljanz is approved as a 1st line biologic, at this point. I bet you'd have to fail remicade/humira 1st with a lot of insurances.
Posted 7/12/2019 1:11 PM (GMT 0)
You guys are great!! Thank you for taking the time out to answer my post. It's good to know that I can take my maintenance dose indefinitely and even increase it if need be. Ipoop... you mentioned that I may need to take more in the way of Asacol if I have low grade inflammation. The problem is.... I have had this condition for such a long time now that, to be honest, I'm not 100 percent certain on what "remission" actually is. My last scope in December showed no active disease and yet, I still need to go to the bathroom rather urgently once or twice a day mainly after eating. I have no pain and no blood ... maybe a tiny bit of mucus but only very occasionally, which leads me to think that I may have IBS as well, which apparently, is possible to have with UC. So a double whammy for me.
Anyway, thank you once again for all your replies. I really appreciate it as it has put my mind at ease that I am doing the right thing. Biologics and the like have always scared me. I'll just stick with what I know. Xx
Posted 7/12/2019 10:33 PM (GMT 0)
"or Asacol enema"

what does that mean ? what does your butt say if you use enemas 7 nights in a row - do your urgency issues improve ?

just curious -
Posted 7/15/2019 2:40 PM (GMT 0)
A mesalamine enema is known by many names, Asacol/Rowasa/salofalk/pentasa/etc. Varies based on country. More often hear Asacol associated with an oral mesalamine pill, but I can see that name being used for enemas too!
Posted 7/15/2019 3:16 PM (GMT 0)
Since you've had UC for over 10 years you should be getting regular scopes to check for colon cancer. When I say regular, I mean yearly. If you haven't had a scope recently, I would recommend getting one as soon as you can. This way you can make sure you're in the clear of CC, which I am sure you are, but you can also find out whether there is inflammation that's causing the urgency.
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