Failed one TNF? Don't give up hope...

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CrohnsDaddy
Regular Member


Date Joined Oct 2007
Total Posts : 235
   Posted 12/21/2008 12:18 PM (GMT -7)   
I've read several postings here on Healing Well and other internet forums saying how if you have failed to have a response to (or developed anti-bodies against) one TNF, then you won't respond to other TNF's. Many of these posts have cited their GI's as their source. Try as I might, I couldn't find any web-based sources for these types of statements. I have, however, found statements like this:

from: http://www.prnewswire.com/cgi-bin/stories.pl?ACCT=104&STORY=/www/story/10-17-2008/0004906487&EDATE=

"Furthermore, data from the WELCOME study showed that 39 percent of
patients who responded to CIMZIA treatment after failing infliximab therapy
achieved clinical remission within six weeks. Additionally, there were no
differences in clinical response rates regardless of the reason for
infliximab failure, and irrespective of treatment as a monotherapy or in
combination with other common Crohn's disease medications.

Response to CIMZIA was similar when used as a monotherapy or with
concomitant corticosteroids or immunosuppressants. There were also no
differences in clinical responses to CIMZIA among those patients who had
previously lost response to infliximab (62 percent), were hypersensitive to
infliximab (61 percent) or both (58 percent)."

I have also found numerous other references to patients failing one TNF blocker, and then having success on another; it isn't just Cimzia-after-Remicade that appears to work.
Just trying to be a "Regular Member".


Entocort 9 mg/day, Prednisone 20 mg/day, started Humira 1/22/08, started 100 mg of Azasan (Imuran) 2/20/08. Increased Azasan to 150 mg 10/15/08. Discontinued Humira 11/03/08 after extreme fatigue and moderate muscle aches. Started Cimzia 12/4/08. Down to 5 mg/day of Pred now, and will continue to taper until completely off as long as the other meds keep me off the porcelain.



I'm convinced that Prednisone is the root of all evil, and primarily responsible for global warming.


sr5599
Veteran Member


Date Joined Aug 2007
Total Posts : 1202
   Posted 12/21/2008 1:16 PM (GMT -7)   
Thanks so much for posting that link! I've been wondering about that with Cimzia... I failed Remicade and Humira both. I was not able to get my insurance to cover weekly shots for Humira or it might have worked better. I am considering trying Cimzia so that I can get off the rectal steroids. my bones would appreciate it!

Cimzia is the only remaining drug on the market that I have not tried. I am almost scared to try it because it gives me hope now! ;-) I plan to contact my GI after new year's and get an appointment to get started. It was either that or the Abbott trial since it has a long open label period. Decisions!
--40 year old female, dx as UC in '04 (1st symptoms in '03), switched to Crohn's in '05, 1 fistula, crohn's colitis, limited to large intestine  --rejected (reaction/didn't work): Asacol, AZA, 6-MP, MTX, Remicade, Humira, prednisone
--Prochymal in Phase III study (can't wait til it's approved!)
--started Tysabri 3/21/08 => STOPPED 10/3/08 - now 2 months into it & it was the right decision
--currently taking budesonide suppositories, 3mg at night.  Doing well with this so far.  Dx Osteoporosis 10/08 waiting to start Forteo (pending approval)
--single mom to 11-yr-old girl


gachrons
Veteran Member


Date Joined Mar 2007
Total Posts : 4527
   Posted 12/21/2008 1:59 PM (GMT -7)   
Hi Thanks for the heads up I was told that if you failed Rem. a person could still try Hum.Some people here will be glad for the info. lol gail
Hallarious woman over 50 ,CD ,IBS 27 years--resection,fistula's,obstructions,hemmies,and still alive.lol gail


tsitodawg
Veteran Member


Date Joined Sep 2006
Total Posts : 845
   Posted 12/21/2008 2:04 PM (GMT -7)   
The information that I was given by my G.I. this week about being more susceptible to failing one TNF medication if you have already failed another previously, was given to him about 2 weeks ago at the National G.I. Conference. This does not mean that because you have failed one then you do not have any other options, but that you must be aware that it is not going to be a sure thing. I have have been on Remicade, and Humira and failed. Remicade worked for about 3 1/2 years and humira never worked and made me really sick. I am currently on Cimzia and so far have not had close to the results that I have had with Remicade. I am also starting to show the same signs of syrum sickness that I exhibited during the last few month on Remicade. You probably won't be able to to find to much information about the correlation between the failure of one TNF inhibitor and the previous failure of another. This information was just released and is still in the early stages of observation. G.I.'s across the country are just now starting to notice it due to increasing amount of patients that have used remicade and are now needing to change. As for the Cimzia talk, most insurances require that you fail Remicade and or Humira before you are even approved for use on it. This is the reason that the Cimza Cimplicity program was developed for financial assistance.

ivy6
Elite Member


Date Joined Sep 2005
Total Posts : 10404
   Posted 12/21/2008 3:19 PM (GMT -7)   
That's fantastic. Thanks so much. I think I'll add this to the "new meds" thread. It's so encouraging - thanks.
Co-Moderator Crohn's Forum.


CrohnsDaddy
Regular Member


Date Joined Oct 2007
Total Posts : 235
   Posted 12/21/2008 5:53 PM (GMT -7)   
sr5599 said...
Thanks so much for posting that link! I've been wondering about that with Cimzia... I failed Remicade and Humira both. I was not able to get my insurance to cover weekly shots for Humira or it might have worked better. I am considering trying Cimzia so that I can get off the rectal steroids. my bones would appreciate it!

Cimzia is the only remaining drug on the market that I have not tried. I am almost scared to try it because it gives me hope now! ;-) I plan to contact my GI after new year's and get an appointment to get started. It was either that or the Abbott trial since it has a long open label period. Decisions!


I didn't try Remicade, but I did fail Humira. I had very little faith when my GI suggested I try Cimzia. Imagine my surprise when it put me in remission. I've had as good of a response to Cimzia as I have to steroids. There were a couple days right before my second set of injections where my CD symptoms came back, but since my second round of shots three days ago, I'm back into full remission. My arthritis pain is just about completely gone, and (and this is the best part), the fatigue is *much* better. I actually had the energy to go shopping today. To me, the fatigue has been the worst symptom of Crohn's next to the stomach cramping and D.

sr5599, I can't tell you how much I hope it works for you if you decide to give it a try. Nothing (and I've tried alot of meds) other than steroids has even come close to giving me this much relief.
Just trying to be a "Regular Member".


Entocort 9 mg/day, Prednisone 20 mg/day, started Humira 1/22/08, started 100 mg of Azasan (Imuran) 2/20/08. Increased Azasan to 150 mg 10/15/08. Discontinued Humira 11/03/08 after extreme fatigue and moderate muscle aches. Started Cimzia 12/4/08. Down to 5 mg/day of Pred now, and will continue to taper until completely off as long as the other meds keep me off the porcelain.



I'm convinced that Prednisone is the root of all evil, and primarily responsible for global warming.


CrohnsDaddy
Regular Member


Date Joined Oct 2007
Total Posts : 235
   Posted 12/21/2008 6:20 PM (GMT -7)   
tsitodawg said...
The information that I was given by my G.I. this week about being more susceptible to failing one TNF medication if you have already failed another previously, was given to him about 2 weeks ago at the National G.I. Conference. This does not mean that because you have failed one then you do not have any other options, but that you must be aware that it is not going to be a sure thing. I have have been on Remicade, and Humira and failed. Remicade worked for about 3 1/2 years and humira never worked and made me really sick. I am currently on Cimzia and so far have not had close to the results that I have had with Remicade. I am also starting to show the same signs of syrum sickness that I exhibited during the last few month on Remicade. You probably won't be able to to find to much information about the correlation between the failure of one TNF inhibitor and the previous failure of another. This information was just released and is still in the early stages of observation. G.I.'s across the country are just now starting to notice it due to increasing amount of patients that have used remicade and are now needing to change. As for the Cimzia talk, most insurances require that you fail Remicade and or Humira before you are even approved for use on it. This is the reason that the Cimza Cimplicity program was developed for financial assistance.


Tsitodawg, I'm sure sorry to hear your luck with TNF blockers has been so yucky.

I know that TNF blockers are very controversial, especially when the discussion of whether or not a TNF blocker will work for a patient that has failed others. However, the quote in my original post is the results of an actual study, not just hearsay; those percentages are actual and factual statistics. Fairly recent ones, too. The date of the article was mid October of this year. Those stats, however, are specific to Remicade failures moving on to Cimzia. They are *not* general stats of moving from any TNF to another TNF. Although I have found other references of other TNF to TNF successes, as well. I was just lazy and posted the one.

The point you made about nothing being a sure thing applies to pretty much everything in life, and especially getting results from Crohn's medications and treatments. The overall response rate to TNF blockers when used to treat Crohn's is depressingly low. It depends on the source you want to quote, but it seems like the average response (people showing either a reduction in CD symptoms or going into complete remission) is less than half of those that try them. Not very encouraging, for sure. It certainly was not my intent to imply that it *was* a sure thing. And I certainly don't see how reading the quoted source could be construed as a sure thing, either.

The insurance companies really do make it tough. Mine groused about going straight to Humira before trying Remicade. My GI convinced them to approve it, though. Then after failing the Humira, they again wanted me to go to Remicade. My GI must have a golden tongue, though, because he was able to get me approved for Cimzia.
Just trying to be a "Regular Member".


Entocort 9 mg/day, Prednisone 20 mg/day, started Humira 1/22/08, started 100 mg of Azasan (Imuran) 2/20/08. Increased Azasan to 150 mg 10/15/08. Discontinued Humira 11/03/08 after extreme fatigue and moderate muscle aches. Started Cimzia 12/4/08. Down to 5 mg/day of Pred now, and will continue to taper until completely off as long as the other meds keep me off the porcelain.



I'm convinced that Prednisone is the root of all evil, and primarily responsible for global warming.

Post Edited (CrohnsDaddy) : 12/21/2008 6:29:01 PM (GMT-7)


CrohnsDaddy
Regular Member


Date Joined Oct 2007
Total Posts : 235
   Posted 12/21/2008 6:34 PM (GMT -7)   
ivy6 said...
That's fantastic. Thanks so much. I think I'll add this to the "new meds" thread. It's so encouraging - thanks.


You're welcome. :)

There's soooo much information out there about CD and all the different meds, it's hard to sift through it all.
Just trying to be a "Regular Member".


Entocort 9 mg/day, Prednisone 20 mg/day, started Humira 1/22/08, started 100 mg of Azasan (Imuran) 2/20/08. Increased Azasan to 150 mg 10/15/08. Discontinued Humira 11/03/08 after extreme fatigue and moderate muscle aches. Started Cimzia 12/4/08. Down to 5 mg/day of Pred now, and will continue to taper until completely off as long as the other meds keep me off the porcelain.



I'm convinced that Prednisone is the root of all evil, and primarily responsible for global warming.

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