there are two issues: Remicade slipping, and will sterroid enemas help.
1) The Remicade seems to be losing effectiveness. It is recommended that you do Remicade in conjunction with an immune suppressant like Imuran so you do not form antibodies that block effectiveness. You can ask for an antibody test to see if your body is rejecting the Remicade.
2) It is possible (if you are not developing antibodies) that a steroid enema might complement Remicade in the hard to treat Rectum. The older/generic ones use the steroid hydrocortisone, which is about
1/4 the potency of prednisone in terms of how well it binds to receptors. (See this chart www.nadf.us/downloads/adrenalhormone.pdf
). The newest player, budesonide, is about
16x of cortison, or 4x of prednisone.
There are budesonide foams and enemas, which may have less side effects because they can be taken in smaller doses do to the 16x receptor binding aspect. However because these are retal meds, most of the effect is topical and side effects are of less concern.
Taking the generic hydrocortisone like Perrgo is usually much much cheaper.
11/08: ischemic colitis and scope perf colon. 12cm colon/ileocecal resected. IV antib:sepsis.
01/10: Dx: Mod. UC pancolitis
. Rx: Lialda 3x.
02/11: Major flare w/antib:sinus. Rx: 40mg Pred taper.
07/11: Histol remiss rt/trans; worse sigmoid. Rx: Rowasa & hydrocort
Curr: 1-2 soft-formed stool, no urgency: Lialda 2x, NO PRED, probiotics, Vit-D/C