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Humira and surgery

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Crohn's Disease
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Posted 4/2/2008 6:17 PM (GMT -7)
I'm trying to find an answer regarding whether I should stop taking Humira prior to surgery. I'm trying to schedule my surgery (resection of stricture in TI) for April 22 or April 29 (surgeon's on vacation, scheduler needs to check with him). My GI says he isn't sure, but he didn't think I needed to stop. He said to ask my surgeon. My surgeon is on vacation. I called My Humira - they said to ask the surgeon. There was no manufacturer recommendation. I asked the drug rep at a recent CCF seminar and he didn't know. He asked the GI on the medical panel who spoke about the biological medications. She didn't know. Does anyone know???? I don't want the pharmacy to send the two injections if I don't need them. I don't plan on taking Humira post-op, although whether or not to continue with Humira post resection is another question without any definite answers.

For those of you who were on Humira around the time of surgery, what did you do?
Posted 4/2/2008 7:07 PM (GMT -7)
The reason you didn't get a straight answer is because no studies were done on this type of situation. Therefore, if you want an answer from someone who has EXPERIENCE with Humira and surgery, I would tell you (or your doctor) to contact one of the following Dr.s (all leaders in treating CD)--Sandborn, Hanour, Rubin, or Dubinsky.

Just from a common sense approach, if you are not planning on continuing Humira after surgery, why do you need to stay on it if you are having surgery in the near future??

FYI--there was a small study (although I cannot remember who did it) that suggested if you took a maintenance med (like an immunosuppresant) it would delay a CD flare.

JMHO :)
Posted 4/2/2008 9:59 PM (GMT -7)
My experience in regards to surgery is not with Humira but Remicade. Since both are in the same family of drugs, then I would guess that the same recommendations would apply. Also, my experience was in the beginning of 2005, and further evidence about risks might have surfaced since then.

I was going to have hip replacement surgery. I was on Remicade and Imuran. My GI said I should keep getting my infusions because it would keep the inflammation down. The ortho who was going to do the hip replacement was adament I stop the Remicade and the Imuran. He said that he had operated on a lot of patients on Remicade [rheumatoid arthritis patients] and that their healing was delayed significantly because of the Remicade.

How was that for a NON answer? I think you are going to have to trust the surgeon on this one.
Posted 4/3/2008 7:35 AM (GMT -7)
My Surgeon and GI both agreed to hold the doses of Humira when I had my surgery in the TI.  I also have a history of MRSA infections from the first bowel surgery so that is the reasoning as to why they decided to hold it as surgery is a major stressor and can lead to any type of infection.  Good Luck.

Jill

Posted 4/3/2008 8:36 AM (GMT -7)
I'm scheduled to have a c-section on April 28. I am also scheduled for a dose of Humira on April 27 (I take it every two weeks). I'm a patient of Dr. Hanauer and he told me to skip the dose on the 27th and just take it when I get home from the hospital. This is both because of the surgery and to restrict the baby's exposure so close to her birth.
Posted 4/3/2008 11:16 AM (GMT -7)
Here's my two cents worth... I had to have my appendix and an ovarian cyst removed unexpectedly a few months back. I was scheduled to take my Humira that night, so naturally I didn't since I was in surgery instead. I contacted my G.I. doc after and he told me to wait for two weeks to take the next dose. I did develop a post op infection, so I was then told to wait until a week after I had finished the antibiotics. It was therefore 6 weeks between shots and did not significantly cause problems at all.
Posted 4/3/2008 2:53 PM (GMT -7)
Thanks so much for all your responses and sharing your advice and experience. You are the real experts! I'll hold off on ordering the Humira this month and confirm with my surgeon when he returns next week.

Chroniyogi and Beth - where does Dr. Hanauer (and the others) practice?

Beth, you had a resection in 2006 and are currently on Humira? Did you take the Humira post-resection to try to avoid a recurrence, or did you have a recurrence, and therefore went on Humira? Good luck with your C-section!
Posted 4/3/2008 4:02 PM (GMT -7)
I had a resection in June and was told to stop with my last dose 2 weeks before surgery.  I did not resume it since I was considered in remission after surgery.  Good luck! 

Posted 4/3/2008 4:30 PM (GMT -7)
Thanks pattytx. I'm glad to hear you're doing well post-resection. Are you on any maintenance medication?
Posted 4/3/2008 6:31 PM (GMT -7)
hanauer is at U. Chicago
Posted 4/3/2008 8:47 PM (GMT -7)
Drs. Hanauer and Rubin are both at Univ of Chicago. I'm not sure about the other 2 mentioned.

I had a recurrence after my resection. The only part where I had active Crohn's was removed in June 2006 and not too long after, a followup colonoscopy showed Crohn's throughout my colon. Yay me. So I started Humira in April 2007. :)
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