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When do you switch to biologic?

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Ulcerative Colitis
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Posted 8/30/2021 8:31 PM (GMT 0)
When I was diagnosed with a moderate to severe proctosigmoiditis I was completely ignorant about the disease. I thought I can treat it as any other. Take a pill for a month or two and be done with it.
I started Mesalamine 1.2g tabs twice a day and Mesalamine suppositories 1000mg the first day of May 2020.
Then in 2.5 weeks GI put me on prednisone in addition to the above.
I started to read this forum and found out about enemas, took a while before GI sent the script.
Started Entyvio and enemas the last week of June 2020
What bothers me that GI pushed to biologic too fast. After reading this forum my understanding is it takes months on mesalamine before things fully calm down.
Make things worse I went for the 2nd opinion to Weill Cornell and a big shot doctor said I had a mild case not severe and doesn’t agree with my GI.
What would you recommend? Can I get off Entyvio? If I do and things get worse can I go back to it?
Posted 8/30/2021 8:43 PM (GMT 0)
Did you ask the new GI those questions? I would ask him or her. I agree that it was too fast. But the most important thing is if you are feeling well. And Entyvio has a very good safety profile. I also believe people rarely form antibodies to Entyvio, but I don't know enough to really answer your questions with any certainty.
Posted 8/30/2021 9:55 PM (GMT 0)
GI's push biologicals more these days because their safety profile is improving but more importantly because the old "Step Up' procedure of dealing with autoimmune conditions is now being changed to a "Top Down" approach....just youtube search for Top Down IBD or Treat to Target IBD and you will get a host of videos on such. The thinking now is that when a person is first diagnosed with moderate to severe IBD there is a window of opportunity of a few months to alter the natural course of the disease and this is best done with using the more powerful drug therapies available. The modern GI will aim to remove all evidence of your disease rather than giving you rectal meds and mesalamine and then crossing his / her fingers and hoping you get better and if not waiting until you become sicker and have more issues to use more powerful therapies. This sort of thinking is becoming a thing of the past.

There are now studies, see Rubin et al, where this Treat to Target approach has been shown scientifically to produce far better long term outcomes than the old Step Up approach. There are of course major financial costs involved as someone has to pay for these very expensive treatments.

Vedo (Entyvio) is a very good drug with the best safety profile of all the third line IBD therapies. If you have concerns about taking this then such is well merited and really this should be a discussion you have with your own PCP and GI who will know more about the specifics of your own particular case.
Posted 8/30/2021 10:42 PM (GMT 0)
2 months wasn't much time unless you were getting worse. Even then if you were only taking 2 1.2g oral you were only on half the max dosage and had only started the enemas.

But as others have said, Entyvio is probably the safest of the biologics and only targets your colon (not systemic).

If you stop Entyvio and max out on mesalamine (oral & rectal) it might be ok. On the other hand, it might cause you to flare. With this disease, it's usually best to keep doing what's working. Are you in remission? Are you still taking mesalamine?
Posted 8/30/2021 11:37 PM (GMT 0)
I wish I had started biologics earlier rather than 3 years of messing around with mesalazines and prednisone

I would tend to trust your GI rather than strangers on the internet
Posted 8/30/2021 11:42 PM (GMT 0)
How are your symptoms? We’re not doctors on here so we can only speak about our experiences or reference studies.

I started with a local GI and it was a disaster, ended up in the hospital for 21 days and being transferred to Mount Sinai for Cyclosporine or surgery. I stuck with the GI at Mount Sinai and followed him over to Weill Cornell. The level of care at these places are much better than most local GI practices.
Posted 8/30/2021 11:43 PM (GMT 0)
What Dr did you see at NYP?? I had my surgery there
Posted 8/31/2021 1:24 AM (GMT 0)
Thank you All for your input. You guys are great!
I made a mistake. I just looked into my records and I was taken Mesalamine 1.2g x 2 tabs twice a day. I was getting better but very slowly. I was inpatient. As I mentioned I was ignorant about the decease and couldn’t understand why after a month being on pills I still saw blood and mucus.
After I started Entyvio my local GI told me to taper down everything else and stop. I insisted on continuing enemas for a while with Entyvio. I am currently on Entyvio only.
I had colonoscopy in December of 2020 and was told I was in remission. The pathology report confirmed it.
I have other GI issues and the symptoms overlap. At the time I was diagnosed with UC I also had endoscopy and had stomach erosions. I had and have constant every day pain on my left side and under my left rib. I also took PPIs for a longer time this time. I lost a lot of weight. I was going to the bathroom a few times a day - big soft piles. Seems like all that went in would come out. I would see undigested food come out. If I had cooked carrots at 6 pm I would see them in the toilet in the morning.
I did ask the doc at Weill Cornell who was surprised I was put on Entyvio so fast with the mild UC but on the other hand NYP GI was ok with it since I have the pain and other symptoms.
As turned out my fat fecal test was positive ( I have another post for this) and I am still awaiting insurance approval to check the small intestine. I can not gain weight, I am 5.5 and 100lb.
I hate taking medication. I have had stomach ulcer/erosions in the past, I would take PPI for 2 months, heal and move on with my life. This time is different. New negative discoveries are just keep piling up.
When one GI organ is not working right it effects the whole GI system and all other parts are starting to misbehave with time.
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