Remicade a bridge for Entyvio?

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RunJerRun
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   Posted 1/11/2018 5:09 PM (GMT -6)   
Has anyone ever heard of using Remicade for a short duration as a bridge until the Entyvio has a chance to kick in?

This was floated past me as a possibility. My past cancer history had me skip Remicade and Humeria as biologic possibilities and start the “safer but slower” Entyvio. I have had a couple infusions and will have the third in two more weeks. I’m currently using prednisone as a bridge but feel like it’s barely making a dent in my symptoms.

If by some chance the insurance were to approve it, what kind of havoc would having two biologics in your system at the same time cause?

Jer

notsosicklygirl
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   Posted 1/11/2018 5:37 PM (GMT -6)   
I haven't heard of anyone doing this. Three entyvio infusions will put you at how many weeks? My GI said if you don't have a response in 10 weeks, the chances of responding are low. If you're getting close to that mark, of course ask your GI, but it may be worth discontinuing entyvio and starting something else. I understand your cancer situation, and the other drugs may be more risky, but there's no reason to continue entyvio if you're not responding to it. Have you had stool tests? What dose of prednisone are you on? Are you using any other medications? They could do cyclosporine as a bridge, that would likely make more sense, but again, no guarantee it will give you a response that lasts beyond the treatment.
Moderator: UC
Currently: no meds 6/15 Step 1 J-pouch Surgery Complete 9/15 Step 2 Complete 11/15 Step 3 Complete
From Sickly to UC Free

Give a man a fish and he will eat for a day; teach a man to fish and he will eat for a lifetime; give a man religion and he will die praying for a fish

RunJerRun
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Date Joined Oct 2017
Total Posts : 72
   Posted 1/11/2018 5:55 PM (GMT -6)   
The third infusion will put me at week 6. That will be on Jan 23rd. I think I can be patient for another month without doubling up biologics. Just HATE the prednisone side effects!


Doing a 40mg prednisone split 20mg am/ 20mg pm (anything above this and I get steroid psychosis) for the past month. I have have stool tests, no C. Diff or anything but good old UC (Pancolitis). I have tried and had no luck with Lialda, Aspiro, Uceris, Cortesol Enemas. I will have to look into cyclosporine.

iPoop
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Date Joined Aug 2012
Total Posts : 13219
   Posted 1/11/2018 6:39 PM (GMT -6)   
I've never heard of using two biologics simultaneously.
Moderator Ulcerative Colitis
John
, 39, UC Proctosigmoiditis
Rx: Remicade @5mgs/kg/6wks; daily 75mgs 6MP, 4.8g generic-Lialda, and rowasa

A semi-finalist in the Olympic 15-meter bathroom-sprint. Aimed for the gold but just ended up getting brown...

UCer23
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Date Joined Aug 2017
Total Posts : 117
   Posted 1/11/2018 7:19 PM (GMT -6)   
I wouldnt think it would work for two reasons.

1) Insurance likely wouldnt pay for both at the same time. Most insurance companies are complete jerks for a lot of people trying to get onto one biologic.

2) If you start Remicade and you start to feel better, how will you know if it is the Entyvio or the Remicade that's working? Essentially meaning your doctor will have to make a best guess as to which is working which isn't ideal for anyone.

I'm on Entyvio now, I'm actually moving up infusions from 8 to 6 weeks. I've had a good response to the 8 week schedule, but my new doctor wants to move up to 6 weeks since they arent allowed to increase my dosage. he's hopeful that will do the trick. Entyvio has been good for me as I really havent had any side effects. like the others have said, it is a slow moving drug that takes time. I personally felt a little better during the loading dosage period, but it was still up and down of good and bad days.

I'm hoping you see a reaction soon. Granted if you do, it will be a very small one at first and wont be an overnight thing. You will start going less, less urgency and blood, etc. You might have that good day streak for a day or two before you have a bad day or so. this drug def isnt a straight ride upwards towards remission.
Currently Taking: Entyvio
Past Meds: Lialda, Prednisone, Humira, Azathioprine

iPoop
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Date Joined Aug 2012
Total Posts : 13219
   Posted 1/12/2018 8:18 AM (GMT -6)   
1.) What's your current prednisone dosage?

2.) Had you considered adding in oral and rectal-route mesalamines (lialda/apriso/delzicol and rowasa)?

3.) Have you considered adding an immunomodulator as a bridge (methotrexate is fast working)? Or are they a no, no due to the past cancer issue? I know 6mp/imuran sometimes isn't recommended for those who've had skin cancer in the past (some have had melanoma relapses due to 6mp/imuran). Not sure if that applies to methotrexate as well. Methotrexate isn't as common as 6mp/imuran for UC patients though!

JGS 75 said...
If by some chance the insurance were to approve it, what kind of havoc would having two biologics in your system at the same time cause?
I don't believe it has been studied. The goal of biologics is to slightly reduce the immune system's ability to request, initiate, and complete an attack. Remicade mutes the request/signal for an attack, and entyvio limits the completion of the attack. You'd just want to make sure you aren't suppressing the immune system too much with dual biologics (I don't know if it would, but that would be the primary concern). As you still have infections, colds, flus, and other things to contend with in our everyday lives.

4.) Your doctor can submit a request to your insurance to see what happens, your situation is unique with the limitations of a prior cancer so maybe it would be considered differently perhaps? I would expect an initial denial. He can appeal and sometimes they are approved.

5.) Has your doctor done remicade as a bridge to entyvio before? What was the results? How many patients? I would ask questions like that. And I'm curious about those answers too!
Moderator Ulcerative Colitis
John
, 39, UC Proctosigmoiditis
Rx: Remicade @5mgs/kg/6wks; daily 75mgs 6MP, 4.8g generic-Lialda, and rowasa

A semi-finalist in the Olympic 15-meter bathroom-sprint. Aimed for the gold but just ended up getting brown...

Post Edited (iPoop) : 1/12/2018 6:23:45 AM (GMT-7)


TheITIS
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Date Joined Jul 2015
Total Posts : 80
   Posted 1/13/2018 8:18 AM (GMT -6)   
notsosicklygirl said...
Three entyvio infusions will put you at how many weeks? My GI said if you don't have a response in 10 weeks, the chances of responding are low. If you're getting close to that mark, of course ask your GI, but it may be worth discontinuing entyvio and starting something else.


Can be longer than 10 weeks before any real noticeable improvement in movements. Based on anecdotal experience I'd push for you to hang in there for another infusion or two.

Have you had a pre-entyvio CRP bloodwork? If so I'd be interested to know what CRP is post 3 (or 4th) infusion and comparing the two.

Something you could go over with your doc. Doing your steroid split with pred in the morning and Uceris in the evenings. I know you mentioned trying and getting no response with Uceris. Might be worth trying it as your evening steroid in place of pred.

Also, are you taking a probiotic? Get the doc to write you a VSL DS script.
https://www.ncbi.nlm.nih.gov/pubmed/15984978
Pancolitis DX:
Fall 2007


Currently on:
Entyvio

RunJerRun
Regular Member


Date Joined Oct 2017
Total Posts : 72
   Posted 1/13/2018 9:18 PM (GMT -6)   
Thanks for the input. I will definitely bring these up these questions with my GI at my appt next week.

On another note, I’ve had four days in a row now with significantly reduced symptoms. Somewhat solid stool, 2 BM’s a day. So either the prednisone is finally doing something (besides making my hands shake and make me want to yell at my kids) or even better the Entyvio might be kicking in! I suppose we will find out as I begin my slow taper. I’m currently down to at 15/15 split (for 3 days) no big withdrawals or return flare yet. Will go to a 15/10 split next week. Crossing my fingers! I want off these steroids so bad! I feel like I forgotten what having a normal brain is like.


DX: Sept 2017 -Left Side UC - Symptoms since Jan 2016
Oct 2017 - Renal Cell Carcinoma
Nov 2017 - Partial Nephrectomy
Dec 2017 - Trip to ER - DX: Pancolitis

Current Meds: Prednisone 30mgs taper. Entyvio - Week 5, Probiotics.
Tried w/ no luck: Lialda, Aspiro, Uceris, Cortesol Enemas

Jaiki
New Member


Date Joined Jul 2017
Total Posts : 12
   Posted 1/15/2018 9:45 PM (GMT -6)   
This is actually exactly how I was put on Entyvio a year ago aha, couldn't find anyone else that had gone through it either! I started Remicade May 2016, but it started failing by Sept 2016. I started on Entyvio in Oct 2016, while continuing my Remicade infusions halfway in between my Entyvio infusions, but ...I still don't know to this day if that helped or harmed me. I ended up having a pretty terrible reaction to Entyvio by my third infusion, but who knows if that was actually the Entyvio, or because of the mixture of that and Remicade in my system, recently being on prednisone, having my flu shot, or some weird mixture of any of those things. I would probably recommend against it, even just for the fact that taking that much medication at once may be hard on your body, despite putting myself through that, but that'll have to be something you think about/talk with your doctor!
Diagnosed: UC (April, 2014), small pulmonari emboli (Dec, 2016)
Currently: Flaring(?), 7-15x/day.
Current meds: Humira, Propranolol, Mirtazipine, CBD oil
Past/failed meds: Remicade, Entyvio, Azathioprine, Cortiment, Salofolk enemas, Pentasa, Dicyclomine, Xarelto, Omeprazole, Pantoprazole
Prednisone when absolutely needed

RunJerRun
Regular Member


Date Joined Oct 2017
Total Posts : 72
   Posted 2/7/2018 12:56 PM (GMT -6)   
Well believe it or not, my GI was able to get the appeal approved to have me try Remicade as a bridge while Entyvio had a chance to kick in. The problem is that it took over 8 weeks to go through the process. I had been on 40 mg of prednisone and now have tapered down to 20 mg. Unfortunately, my symptoms have come rearing back. I’m not back to the 20+ BM’s Previous to pred but, am going 10+ Lots of blood and pain.

I have a appt with a surgeon this afternoon. Based on our last appt, I have a feeling he is going to recommend surgery soon (3-step, because current health) and not want me messing around with the Remicade. After taking a look at my CT scan and rectum, he couldn’t believe I was still able to go to work. I told him it hasn’t been easy, but someone still has to buy groceries.

My question is, am I being rash by moving forward with surgery and not try remicade for a few infusions to truly give Entyvio a chance? Based on Entyvio’s website, it looks like I should see some results by week 10. I’ve had 3 infusions and am just over 8 weeks. Haven’t seen a flick of relief yet. My UC just seems to ignore medication.
DX: Sept 2017 -Left Side UC - Symptoms since Jan 2016
Oct 2017 - Renal Cell Carcinoma
Nov 2017 - Partial Nephrectomy
Dec 2017 - Trip to ER - DX: Pancolitis

Current Meds: Prednisone 30mgs taper. Entyvio - Week 5, Probiotics.
Tried w/ no luck: Lialda, Aspiro, Uceris, Cortesol Enemas

iPoop
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Date Joined Aug 2012
Total Posts : 13219
   Posted 2/7/2018 1:26 PM (GMT -6)   
Based on what I've read here, 12-14 weeks is as long as some will wait on entyvio. I'd think you'd be experiencing some symptom improvement by week 10... Dunno what do others think?

Hard to say whether you are being rash. Often two biologics are failed before surgery. Is entyvio the only biologic you've tried or have you tried remicade/humira? Generally 6-weeks or less on an improvement if you will get one on remicade/humira. It's preferrable to keep one's large intestine, if your UC can be put into a remission with medical treatment. However, some of us are just refractory (that is a non-responder) to all UC medications and surgery quickly finds them.

Quality of Life is a big one too. If you're in pretty bad shape and suffering then it might expedite your choice.
Moderator Ulcerative Colitis
John
, 39, UC Proctosigmoiditis
Rx: Remicade @5mgs/kg/6wks; daily 75mgs 6MP, 4.8g generic-Lialda, and rowasa

Boss makes a dollar while I make a dime and that's why I poop on company-time...

RunJerRun
Regular Member


Date Joined Oct 2017
Total Posts : 72
   Posted 2/7/2018 1:36 PM (GMT -6)   
My case is a little unique because of my past cancer history. The normal options for biologics are limited because of my higher risk. Entyvio was offered as a “safer” choice.

Yes quality of life is a big part of my decision. Right now, I’m existing but, it is miserable and my patience is getting thin.
DX: Sept 2017 -Left Side UC - Symptoms since Jan 2016
Oct 2017 - Renal Cell Carcinoma
Nov 2017 - Partial Nephrectomy
Dec 2017 - Trip to ER - DX: Pancolitis

Current Meds: Prednisone 30mgs taper. Entyvio - Week 5, Probiotics.
Tried w/ no luck: Lialda, Aspiro, Uceris, Cortesol Enemas

Casey_LB
Regular Member


Date Joined Mar 2015
Total Posts : 218
   Posted 2/7/2018 9:40 PM (GMT -6)   
My symptoms improved on Entyvio after one month, but I think that was primarily due to simultaneously starting hydrocortisone enemas. But I was better at 3 months than at 1 month, better at 6 months than at 3 months, better at 12 months than at 6 months, better at 24 months than at 12 months.

That is, with some ups and downs, my improvement on Entyvio has been gradual over two years. So it can take a long time for improvements to show up.
Male 54
Dx'd w/ UC 2013, flare since 4/14
Asacol HD 800mg, 6/day
Start Remicade 12/14, nonresponsive, DC'd 3/15
Start Humira, 8/15, nonresponse, DC'd 12/15
Hydrocortisone enemas helped, regressed after stopping,

Start Entyvio 12/2015.
Restart hydrocortisone 12/2015
Start UMass IBD_AID diet 12/2015
Improved w/ Entyvio, hydrocortisone, IBD-AID
Colonoscopy showed clinical remission in 1/2017.

notsosicklygirl
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Date Joined Dec 2008
Total Posts : 16731
   Posted 2/7/2018 10:34 PM (GMT -6)   
I don't think it's rash to consider surgery. It sounds like you've had this illness, and treatment of it, consume a lot of your time and energy. 10-20x a day, with bleeding, while getting to work and supporting yourself and a family, leaves very little time to have a good QoL. Even if entyvio worked, how well would it work, and how long would it last? I am probably alone in feeling this way, and I am aware that surgery can have diverse results, but sometimes it is unavoidable. For me, it has simplified my life, made me more capable and allowed me to move on. I can't imagine where I would be right now if I had continued with treating instead of curing. Yes, I use the bathroom more, but it's quick, painless and not urgent.
Moderator: UC
Currently: no meds 6/15 Step 1 J-pouch Surgery Complete 9/15 Step 2 Complete 11/15 Step 3 Complete
From Sickly to UC Free

Give a man a fish and he will eat for a day; teach a man to fish and he will eat for a lifetime; give a man religion and he will die praying for a fish

RunJerRun
Regular Member


Date Joined Oct 2017
Total Posts : 72
   Posted 2/8/2018 5:31 PM (GMT -6)   
NSSG, it's taken some time, but I came to your same reasoning. In fact, after meeting with the surgeon yesterday and consulting with my GI, it looks like we are moving forward with surgery. They have scheduled me for the 22nd. Based on my condition, he said he'd like to do it sooner.

So here we go. As much as I don't want to go down the surgery road, I'm at peace with it. The thought of having a chance a living again is almost exciting. A world without prednisone and crapping my pants as I run to the toilet at work, being able to get off the couch at night and help my kids with their homework. Man, the thought of that alone makes it all a little less scary.
DX: Sept 2017 -Left Side UC - Symptoms since Jan 2016
Oct 2017 - Renal Cell Carcinoma
Nov 2017 - Partial Nephrectomy
Dec 2017 - Trip to ER - DX: Pancolitis

Current Meds: Prednisone 30mgs taper. Entyvio - Week 5, Probiotics.
Tried w/ no luck: Lialda, Aspiro, Uceris, Cortesol Enemas

notsosicklygirl
Forum Moderator


Date Joined Dec 2008
Total Posts : 16731
   Posted 2/8/2018 7:44 PM (GMT -6)   
Please keep us in the loop. I would love to hear your story as you go through it, and even more so, hear about how well you're doing once you've settled into life with your pouch. It's a tough road, but the road with UC is tough in itself, so either way, there are a lot of difficult decisions, but you're right, the potential of being well after surgery, and living a life without the limitations of UC is very exciting and liberating, not to mention, easier and less expensive. It also seems safer than pumping all these drugs into your body. I know not everyone has a fantastic result, but an experienced surgeon increases the chances of a successful outcome. There are statistics that show over 90% of people are happy with their QoL after.
Moderator: UC
Currently: no meds 6/15 Step 1 J-pouch Surgery Complete 9/15 Step 2 Complete 11/15 Step 3 Complete
From Sickly to UC Free

Give a man a fish and he will eat for a day; teach a man to fish and he will eat for a lifetime; give a man religion and he will die praying for a fish
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