I believe the clinical recommendation is to start at a high dosage of xeljanz, and then decrease dosage for maintenance. That reduces the odds of PE and other side effects over the long term. I would discuss the odds of side effects, and risks versus benefits with you gasteroenteroligist. Entyvio also has small odds of serious side effects, as well. Understanding the risks versus benefits is an important part of the discussion Xeljanz risks versus benefits
The most common side effects with Xeljanz (seen in between 1 and 10 patients in 100) are headache, infection and inflammation of the nose and throat, diarrhoea, nausea (feeling sick), joint pain and hypertension (high blood pressure).
The most common serious side effects seen with Xeljanz are serious infections such as pneumonia (infection of the lungs), cellulitis (infection of the deep skin tissue), herpes zoster (shingles), urinary tract infection, diverticulitis
infection affecting the intestines) and appendicitis (infection of the appendix) as well as opportunistic infections that can occur in patients with weakened immune systems
Source: https://www.ema.europa.eu/en/documents/overview/xeljanz-epar-medicine-overview_en.pdfEntyvio risks versus benefits
Entyvio should be inherently safer than other 100% systematic biologics (like remicade, humira, and simponi) are, as Entyvio is a Site-Specific-Immunomodulator that targets just the gastero-intestinal tract. Safer as you're only suppressing the immune system within a specific region of your body, it is less likely that you'd get infections elsewhere within your body as would be the case with systematic Remicade.
What kind of side effects could you get and what are the odds? Everything carries a small degree of risk and it's good to understand what that's all about
. Let's delve a little deeper into risk."about 4% of patients experience infusion-related reactions either at the time you are receiving your medication, or within 48 hours of it."
Infusion reactions are headaches, raised body temperature, flushing of the face, fatigue and other things which are generally quite minor. Infusion-reactions are often prevented by taking tylenol and claritin/benadryl prior to the infusion itself. "In clinical studies, approximately 25% of patients treated with Entyvio developed an upper respiratory tract infection at some point. These include bronchitis (inflammation of the airways), influenza (flu),
nasopharyngitis (inflammation of the nose and throat) and sinusitis (inflammation of the sinuses)."
Entyvio is lowering your body's ability to fight off infections within the GI-tract, so you are going to be more prone to them as a consequence. It's the kind of thing that if you suspect you have an infection needing antibiotics then you should seek out treatment earlier, and sooner. GI-tract infections will develop faster and the symptoms will be worse while on Entyvio. As a general rule with all biologics they say you might, as an example, get an extra flu/cold a year than your normal. So, you're not super prone to them, by any means. Rather it is just an increased risk and something to be cognoscente of, and remain vigilant of while on it.
Entyvio does include a black box warning for PML, despite it never occurring to anyone taking that medication during the clinical trials or since it has been prescribed to patients. Entyvio was specifically designed to not cause PML, as predecessor medications within its class had done by using a different method of action.