Humira or Pill Therapy?

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Easier2Run
Regular Member


Date Joined Nov 2008
Total Posts : 62
   Posted 1/14/2009 10:14 AM (GMT -7)   
I just had a colonoscopy Monday because I was having GI bleeding. The doctor found Crohns all over my bowels, especially at the surgical site where I had my bowel resection last year. He told me to think about if I wanted to go with more pills... probably adding Pentasa, Imuran, and maybe another one? Or go with shots.. like Humira. I know both have side effects, and I'm really not sure which route to go. I just want remission. I've been miserable. I have done Remicade in the past for about a year and a half, but I ended up failing it. I would really appreciate some opinions on this matter.
-Heather, 23 yrs. old
____________

- Crohns disease since 1995, officially diagnosed in 2003.

- Bowel resection in Dec. 07, Crohns reoccurred July 08.

- Medications - Entocort 9mg, Wellbutrin SR 150mg, Lexapro 20mg, Bentyl 10mg, Levsin, Trazadone 50mg, Prednisone taper


patientspiders
Veteran Member


Date Joined Jul 2005
Total Posts : 733
   Posted 1/14/2009 10:35 AM (GMT -7)   
I'm sorry you're having such a rough time, Heather. Choosing meds is much more difficult than most people realize...

When I need to pick a new med, I kind of visualize a triangle or hierarchy of sorts. I see "natural" stuff and vitamins at the bottom/widest part... they're safe, but they can also be the least powerful as far as mounting an attack against your crohn's and sometimes to cover everything it seems like it takes 27 different horse pill vitamins a day.

Next up on the pyramid I see the pills like Purinethol and Imuran, etc. They are more aggressive than the "natural" remedies, but also come with greater risk.

At the top of the pyramid I see the biologics like Remicade and Humira. These drugs mount a full-on attack to actively combat your disease, often providing relief in a fraction of the time that the other methods can take. But again, the increased aggressive nature also increases the seriousness of the side effects.

In order to choose a new med, I usually choose which step on the pyramid I feel is necessary. Am I at my wits end and ready to do whatever might work regardless of potential long term effects? When I was diagnosed my answer was yes. I started Remicade within a few months of being diagnosed.

Is my quality of life compromised, but maybe not bad enough to warrant such powerful stuff? Will the potential side effects of the biologics stress me out so badly that they won't work? I've been here before too and stepped down from the biologics to the pills.

Or, am I in a position where I can take a little more time and pay a little more attention.. enough so that I could try to integrate some natural therapies without spiraling further downward in the mean time? That's where I am now, getting ready to start some new supplements and learn yoga for stress relief. If that doesn't cut it, I'll probably start researching pills again.

I don't know if that'll help ya, but that's how I wrap my brain around things. I hope you find the info and help you need, Heather, and that you start feeling better soon! I'll be thinking about ya.
27f, dx'd CD July '05 after 6 fistula/abscess surgeries
(miscarried at 13 weeks, now waiting to heal before trying again)
Stopped Humira August 22nd, 2008.
Went Gluten-Free, noticing some definite improvement.
Started LDN October 27th, and already LOVING IT.

"Our greatest fear is not that we are inadequate, but that we are powerful beyond measure."


ZenaWP
Veteran Member


Date Joined Aug 2007
Total Posts : 884
   Posted 1/14/2009 10:42 AM (GMT -7)   
Easier2Run, it's something that you will have to decide, as difficult as that is.  Like patientspiders said, it's what you are comfortable with.  I have no problem taking biologicals.  I tried Pentasa and 6-mp previously and nothing seemed to work until we got to the biologicals.  Remicade, Cimzia and Humira put me into remission and have kept me there and I don't know what I would do without them.  But, it's something you have to decide based on what you are comfortable with and can afford.  The pills are usually much cheaper, so a lot of people have to try them first and not get good results in order to get insurance to cover the biologicals. 

Crohn's Disease, Acid Reflux/Gastritis, Hashimoto's Thyroiditis, Endometriosis, Arthritis, Depression/Anxiety.  Too many meds to list them all.  =) 


Nanners
Elite Member


Date Joined Apr 2005
Total Posts : 14995
   Posted 1/14/2009 1:35 PM (GMT -7)   
I think I would try the Immunesuppressants first and if that don't work go up to the Humira. Just my humble opinion. I think that Patientspiders had some good thoughts on this.
Gail*Nanners* Co-Moderator for Anxiety/Panic Forum
Been living with Crohn's Disease for 33 years. Currently on Asacol, Prilosec, Estrace, Prinivil, Diltiazem, Percoset prn for pain, Zofran, Phenergan, Probiotics, and Calcium and Xanax as needed. Resections in 2002 and 2005. Also diagnosed with Fibromyalgia and Osteoarthritis and Anxiety. Currently my Crohns is in remission.
*Every tomorrow has two handles.  We can take hold of it by the handle of anxiety, or by the handle of faith"*

LMills
Veteran Member


Date Joined Apr 2008
Total Posts : 1753
   Posted 1/14/2009 4:33 PM (GMT -7)   
My doctor put me on the tablets first with a combination of pentasa, alinia, and a prednisone taper. Those worked fairly well, but since symptoms didn't seem to abate he put me on humira last semester so out of all of those I am taking pentasa, humira, and still tapering down with the prednisone. It seems to be working well, but I can't tell how much progress can be attributed to the medicine and how much to the steroids. In any case, I wish you the best of luck. There really is no telling what is best for us until we try it..
20 years old, Diagnosed with moderate to severe Crohn's and Colitis in May of 2008.
Currently taking:
Prednisone 20 mg, pentasa 2 pills 4x a day, bentyl as needed, omeprazole in the morning, multivitamin, humira every other week, and good probiotics.
Surgery for ectopic pregnancy most likely the result of severe Crohn's inflammation in July of 2008.
Attempting a diet without refined sugars, high fat content, bleached or bromated flour, most dairy, red meat, and avoiding anything spicy like the plague. Also refuse to eat anything with trans fat or high fructose/corn syrup.
"He who has a why to live for can bear with almost any how."


momb
New Member


Date Joined Jan 2009
Total Posts : 3
   Posted 1/24/2009 8:02 AM (GMT -7)   
Heather -- try the Humira. I have a relative who has been on the medication for 1 1/2 years now ... with no side effects. She can now go to school and attend everyday events without Crohn's running the show. It takes about 20 seconds to give yourself a shot and then you can get on with your life. You can alternate legs every other week. At first it seems scary, but it's well worth it.

CrohnieYogi
Regular Member


Date Joined Oct 2006
Total Posts : 367
   Posted 1/24/2009 9:05 AM (GMT -7)   
Hi Easier. Every one of us here have come to the same juncture you are at--time to try new therapy, which do I go with? There are benefits and risks to each of the meds you mentioned. The immunomodulators (6-MP, Azathioprine, etc) have to be monitored super close and there is risk of liver damage. However, many people have found great relief with them. The Anti-TNF's mean some sort of needle (Remicade is IV infusion, Humira and Cimzia are sub-q injections). There is a risk of infection (as with immunomodulators), but again, many people have found great relief with the tnf's.

Think of this as a time for healing. Do some research and try something new! Good luck!

caroline_r
Regular Member


Date Joined Apr 2004
Total Posts : 94
   Posted 1/24/2009 11:35 AM (GMT -7)   
Hey! I think patientspider has definitely made some good points. You really have to know a lot about your disease, about the medicines that are out there and about how every decision you make about your CD affects your life.

I have a few pieces of advice for you. Before you decide whether you want to take Imuran or Humira make your doctor do this genetic test for Imuran. This genetic test shows if your body would block Imuran I guess. It's still not a guarantee that Imuran will work for you since only 30-40% percent of people respond to Imuran, but there's no point of you taking it if this genetic test proves that Imuran isn't for you. I have no idea how it's called, I just know I had it and it came out ok, I started taking Imuran, haven't had any big side-effects minus the fact that my leukocytes are under the normal level. I started with 100mg and waited for about 3 months and it wasn't really helping so we increased it to 125mg (it all depends on how much you weight) and it started working. We were patient and I'm so glad that we didn't switch to Remicade right away.

For me Imuran made a huge difference, it kept me from having a surgery yet, I have a stenosis but it's doing pretty ok now! The only thing that Imuran didn't fix for me is my anal canal inflammation, which is why now I have to choose between Humira and Remicade, after being on Imuran for 2.5 years. Imuran is a powerful drug, it really is and it's no joke...but those are pills and it's definitely easier to live with pills (but then again "easy" is relative since Humira doesn't take much of your time). If you choose Imuran please know that it might make you feel sick - some people can't deal with it, others say you have to overeat yourself before taking it and that you won't throw up then, and some people like me take Pantoprazole in the morning.

Humira is a powerful drug too, it can help you so much. But just like patientspider I put it at the top of my pyramid list. I've always thought that Humira/Remicade would be my last resort since there isn't anything else after that and life is long. But sometimes you just can't have it the way you want it. All in all...just do this genetic test and then make your decision. I hope everything goes well!

:) Be strong
21 yr. old with crohn colitis. First symptoms in June 2003, diagnosed in March 2004. Been in remission on mesalazine till June 2006 (actually till January) and then on steroids and Imuran. Currently taking Imuran and metronidazole (was taking ciprofloxacine for a month and then switched to metronidazole). No surgeries so far.

Post Edited (caroline_r) : 1/24/2009 11:48:25 AM (GMT-7)


Jessica28
Regular Member


Date Joined Jan 2009
Total Posts : 21
   Posted 1/26/2009 7:19 AM (GMT -7)   
My doctor put me on Humira after my second flare of Crohn's. The more I read, the more afraid I am I started wtih something too strong, too quickly. But it has been wonderful for me. I have had no symptoms since I began treatment in April.
I'm wondering though if anyone thinks I got on Humira too quickly. I just went with the advice of my doctor and didn't do much research on my own.
Jessica
 
28 years old, diagnosed with Crohn's  in March, 2007.  Currently taking Humira 2 X month

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