Remicade a bridge for Entyvio?

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JGS 75
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Date Joined Oct 2017
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   Posted 1/11/2018 3:09 PM (GMT -7)   
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 3:37 PM (GMT -7)   
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.
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JGS 75
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Date Joined Oct 2017
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   Posted 1/11/2018 3:55 PM (GMT -7)   
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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   Posted 1/11/2018 4:39 PM (GMT -7)   
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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Total Posts : 76
   Posted 1/11/2018 5:19 PM (GMT -7)   
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 : 11281
   Posted 1/12/2018 6:18 AM (GMT -7)   
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
Regular Member


Date Joined Jul 2015
Total Posts : 79
   Posted 1/13/2018 6:18 AM (GMT -7)   
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

JGS 75
New Member


Date Joined Oct 2017
Total Posts : 4
   Posted 1/13/2018 7:18 PM (GMT -7)   
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 : 7
   Posted 1/15/2018 7:45 PM (GMT -7)   
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
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