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Steroid rectal meds: Uceris vs. Cortifoam or...?

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Ulcerative Colitis
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Posted 4/25/2021 11:26 PM (GMT -6)
Hey y’all,

I use Rowasa every night for maintenance and do pretty well with it, though I can’t quite get my rectal inflammation into complete remission. Thinking of adding a steroid foam in the mornings for a little while to see if that will do the trick.

Anyone had luck with using these short-term? I know every body is different. I’m just curious to hear from people who have tried steroid rectals... seems easier to use foams vs. liquid or supps during the day but I’m open to whatever tends to be more efficacious.
Posted 4/26/2021 11:12 AM (GMT -6)
It's helped some, try and see. Some use one rectal-route med in the morning and a different one at night.
Posted 4/26/2021 5:34 PM (GMT -6)
Back when I had a colon and rectum and I was having a proctitus flare I used uceris rectal foam on three occasions.

It induces remission, but it was not quick. It usually took 42 days/6 weeks for complete remission for the particular episode.

Insurance stopped paying for it, but I wanted a non systemic steroid . I would recommend it.

It would seem to induce remission after a week, but then I would get blood again,, but after the 6 weeks the therapy worked.
Posted 4/27/2021 2:04 AM (GMT -6)
Thanks peeps... I’ll talk to my GI about it. Unfortunately he wanted to give me a week of prednisone and said he hoped after that I could “ideally control it with Lialda alone.” I don’t want systemic pred ever if I can avoid it and I don’t think I need it. This is the second GI that has tried to get me on it. Nope. I’m looking to exhaust every rectal med combo possible before I step up to heavier systemic meds.

My inflammation has been mild and in the same area (recto-sigmoid) on and off for years. It just gets *really* stubborn sometimes.
Posted 4/27/2021 10:05 AM (GMT -6)
One cannot control rectal inflammation with Lialda...period.

Try the steroid foam in the morning and mesalamine at night.

q
Posted 4/27/2021 3:55 PM (GMT -6)
Definitely going to give it a shot! I requested a foam from the GI and his response was he doesn’t think I would “get any added benefit from it.” I’ve got an appointment next month and I’ll have to demand it. Starting to think my doc is subpar.
Posted 4/28/2021 1:00 AM (GMT -6)
Probably graduated at the bottom of the class...lol.

Always worth a try, why do you have to wait till next month...Call now and request a rx for a month. At least you will have something to discuss then....and set up another plan if needed at that time.


Are you on probiotics? Fibre supplements?
q
Posted 5/13/2021 3:59 PM (GMT -6)
Hey q,

Not taking fiber or probiotic. I do eat a high fiber diet and probiotic-rich foods though...

Had an appointment today. The GI refuses to write me a steroid rectal script. In fact, he doesn’t think I should be on nightly rectals as maintenance at all. His advice is to stop them (tapering not necessary), take 4.8g Lialda per day, and if those don’t prevent flare activity I should step up to a higher tier med. He’s also saying the occasional bleed I have could be the internal hemmies. He may be right there but he certainly can’t say for sure.

This is the second doc that tried to get me on a week of prednisone to calm inflammation further too...He says 5-ASA tablets should control rectal inflammation at the high dose. It all sounds wrong to me. I’m getting handed back to a physician’s assistant now and am seriously considering going to a different clinic for another opinion. Pardon my venting but I’m frustrated right now. I get mad when the doc doesn’t give me at least partial reins to dictate my therapy.
Posted 5/13/2021 10:01 PM (GMT -6)
I'd be doing more than venting. It's unfortunate about your doctor not allowing you to try steroud rectals. If you're able to get into another clinic, I think it will be worth your while.

My opinion...high doses of oral mesalamine won't
heal the rectum or prevent flares considering they start there.
You could ask him if you can try another mesalamine rectal such as Pentasa.

q
Posted 5/21/2021 5:08 PM (GMT -6)
I’m bumping up to 4.8g Lialda to see if it makes a difference in conjunction with the Rowasa. Going to try that for a month-ish. Will see how that works. If it isn’t satisfactory I’ll add a steroid rectal in the morning for a while, assuming I can get a new doc who will allow me to experiment. My current GI is hellbent on getting me off rectal meds completely which seems like nonsense. Hoping to get a fresh opinion soon. Wish me luck!
Posted 5/22/2021 12:12 AM (GMT -6)
Worth trying and making the effort for a new doctor. Yours sounds like an idiot...he has no logic and doesn't seem impressed by the effort you're willing to put in. He's also remiss to refuse a logical and most basic treatment option.

Keep us updated.

q
Posted 6/17/2021 12:29 PM (GMT -6)
Good news: I have been nearly symptom-free since the bump up to 4.8g Lialda almost a month ago. The blood stopped instantly. Stool was mushed up for a few days after the bump but that subsided. Normal for me is 2 to 3 easy to pass soft BMs and that’s where I am. Interestingly, this happened when I first started at 3.6g though it only lasted a week and a half. Also, a couple of side effects only lasted for about that time... Mind I’ve been on nightly Rowasa the whole duration. Doesn’t look like I need an extra rectal med in the mornings for now.

Mesalamine really works for me... I’m hoping that I just needed a higher dose to settle the inflammation down. I’m going to stay on this regimen for at least another month, then will try a Rowasa taper. Not sure how to taper the Lialda or if I even should.

Haven’t gotten in with a new GI clinic though that’s still in the plan. Trying to find one that takes my insurance which is a process... either way once I change I’ll be hoping for a doc that respects the utility of rectal meds for maintenance rather than one that frowns on them.
Posted 6/19/2021 11:57 PM (GMT -6)
Generally mesalamine isn't something you should taper. If you respond well to a potent dose of mesalamine I highly recommend Apriso. It is a newer and arguably better formulation of mesalamine, because it has a better delivery system that prevents it from starting to release too early (in the small intestine). If your insurance will approve it, it is very cheap with the copay card.

It is just 4 pills once daily.
Posted 6/20/2021 7:23 AM (GMT -6)

Guigsy said...
Unfortunately he wanted to give me a week of prednisone and said he hoped after that I could “ideally control it with Lialda alone.”

One week of prednisone...? That wouldn't do anything. A normal course is at least 4-6 weeks with a taper. Really odd any GI would recommend that.

I've never used the foam enemas. I asked my GI about adding those in one time but he said the data doesn't show that to be any more effective than mesalamine enemas so I never tried both.
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