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Change of treatment coming... need advice

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Ulcerative Colitis
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Crazydad
Regular Member
Joined : Sep 2017
Posts : 67
Posted 2/12/2020 11:58 AM (GMT -6)
My son was in remission from April 2018 till Nov 2019 on Entyvio (6 weeks), nightly mesalamine enema/suppositories, 5x750 balsalazide. Minor symptoms returned in mid Nov and little by little the situation got worse. We tried cortenemas, Uceris pills, added curcumin. all helped a bit, but the trend downwards continued. Two weeks ago he had to start prednisone (40 mg). It helped, but not enough. Two weeks ago 7-8 bms, sometimes a bit of blood on stool and bloody mucus. Now, 5-6 formed bms (most of them low amount) and bloody mucus once a day in average.

Colonoscopy was conducted last Thu, showing moderate inflammation in rectum and mild in very lower part of sigmoid, next to rectum. The rest of his colon looks fine. Entyvio level was measured and it was 35, high enough. So, no point of increasing the dosage or frequency of Entyvio, according to our GI.

GI suggests we try Stelara or Xelinaj. We never had a love affair with Entyvio, as it took us more than a year, plus nightly rectal meds and oral 5-ASA and short course of 6MP, to get in remission. So, it may be a right idea to give up on it. But I am anxious to go for biologic #3. Really hopeful it will work this time.

Stelara or Xelianj? Shall we also try Imuran, although we had to stop 6 MP in the past (it eliminated symptoms, but produced liver toxicity). Anything else?
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iPoop
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Joined : Aug 2012
Posts : 16211
Posted 2/12/2020 12:26 PM (GMT -6)
A tough one, although high levels of entyvio and moderate inflammation does sound like a failure of entyvio.

Stelara and Xeljanz are both know to be fast acting 6 weeks or less.

Stelara's loading dose is via an IV, after which you do subcutaneous shots (just below the skin) at home just like Humira.

Xeljanz is a simple pill to swallow, no IVs or shots. There is some concern about blood clotting with xeljanz, something to discuss with his doctor and see if he's in high risk already or not.

Imuran is metabolized by the body into 6MP, so I would not expect any different results. You are not allowed to be on 6mp/Imuran concurrently if you do go the xeljanz route. I believe 6mp/Imuran are fine on Stelara (but not certain).
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