05-14-2019, 01:43 PM   #1
John Doe
 
Join Date: May 2019
Three biologics

Hello I am new here and have been going through a bad flare. I wanted to know if anyone has been on three biologics before and if it worked for crohns.
05-14-2019, 02:45 PM   #2
Shmili
 
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Join Date: Apr 2017
Not sure if that's your question but I am now on to my third biologic medication for Crohn's disease.

I was taking Remicade (infliximab) for about 4 years, I started after having a bad flare ending up in the hospital.

Along the time the Remicade started wearing out and my doctor increased the dosage to it's max but even that stopped working with more time passing.

At that point I switched doctor and she started me on Entyvio right after it was approved in the US for Crohn's, it worked very well for about 1 and a half year but then it started to wear off as well.

So I ended up in the hospital again with an even worse flare up I was released from hospital with a PICC line and TPN IV nutrition for about 1 and a half year, in the meantime I started Stelara injections and slowly it kicked in and I'm now taking a Stelara injection every 4 weeks and so far it works very well for me.

Hope this helps.
05-14-2019, 03:28 PM   #3
John Doe
 
Join Date: May 2019
Sorry for not being clear my question was actually meant to say 3 biologics at the same time. Nevertheless, thanks for sharing your experience I canít imagine not being able to eat for a year and half glad stelara is working for you.
05-15-2019, 08:19 AM   #4
lgpcarter
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Join Date: Jun 2013
Location: Canada

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I don't think they would put you on 3 at the same time. I am on 2 (Entyvio and Stelara) and that is pretty rare. I did Entyvio and Humira for a year but have recently dropped the Humira for Stelara.

Which three are you considering? The immune suppression would be too great I think.
__________________
Diagnosed in with Crohn's in large and small bowel in 2000. Fistulas followed soon after.

Seton placement (2) and fistulotomy December 2013. Setons removed July 2014. 3 more setons June 2018.

Laparoscopic Right Hemicolectomy July 2016, 25 cms removed

Current meds: Entyvio every 4 weeks, Stelara every 8 weeks, B12 every 2 months, Vitamin D 2000 IU

Previously: Remicade, Simponi, Pentasa, Sulphasalazine, Entocort, Methotrexate, Prednisone, Imuran, Humira, Cipro and Flagyl.
05-15-2019, 02:44 PM   #5
John Doe
 
Join Date: May 2019
I don't think they would put you on 3 at the same time. I am on 2 (Entyvio and Stelara) and that is pretty rare. I did Entyvio and Humira for a year but have recently dropped the Humira for Stelara.

Which three are you considering? The immune suppression would be too great I think.
Iím on stelara Entyvio 6mp and 60mg prednisone and I figured we could drop the prednisone and put Any anti tnf like Remicade Cimzia or whichever I believe theirs a lot of anti tnfs
05-15-2019, 06:44 PM   #6
Maya142
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That would be very unusual - I have never heard of 3 biologics being used before. It's hard enough to get two biologics covered, since there aren't many studies to support the use of two biologics yet. I can't imagine any insurance company covering 3 biologics, given the expense. It is more likely you'd be able to get a higher dose of the biologics you are on, rather than adding a third one. For example, are you on 90 mg Stelara every 8 weeks?

Because if so, it could be made more frequent - such as every 4 weeks. I will tag my little penguin because her son is on two biologics, and one of them is Stelara.

The dose or frequency of Entyvio could also be adjusted.

Another option might be to add a second immunomodulator. That is more common than adding a third biologic. So for example, you could add something like Methotrexate to your treatment plan.

My daughter is on 2 biologics and 2 immunomodulators, for both Crohn's and Ankylosing Spondylitis (a type of inflammatory arthritis).
__________________
Mom of M (20)
diagnosed with Crohn's Disease at 16
Juvenile Idiopathic Arthritis at 12
Juvenile Ankylosing Spondylitis at 16

Mom of S (23)
dx with JIA at 14
Ankylosing Spondylitis at 18
05-15-2019, 07:30 PM   #7
John Doe
 
Join Date: May 2019
Unfortunately I already receive both every 4 weeks at 90 mg/ 300mg which is the highest dose right? I canít add methotrexate because of side effects and I donít think other immunomodulators are even effective. That is why I think a third biologic is my only choice but I would love to hear any more suggestions.
05-15-2019, 07:58 PM   #8
Maya142
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I honestly have never heard of using 3 biologics at once. I guess your doctors would have to determine whether it is safer to increase the dose of your current biologics further or whether to switch either Entyvio or Stelara for an anti-TNF. That would still mean you'd be on two biologics.

Another option might be Tacrolimus. It's used for refractory Crohn's. It's not a biologic - it's an immunosuppressant. It is typically effective but it is hard on the kidneys.

You could also try to switch from Prednisone to something like Entocort or Uceris - they are still steroids, but are mostly topical, so they are much safer than Pred and some GIs do use them as maintenance meds.

You could try adding something like Cipro or Flagyl, though they're usually used for the short-term and not as a maintenance treatment.

Besides those things, I guess a third biologic would be an option. Did your GI say if he/she had other patients who were on 3 biologics? I'm asking mostly out of curiosity - my daughter is on two biologics and it took MONTHS of appeals to get both approved. 8 months, if I remember correctly.

So based on our experience, I just can't imagine insurance paying for 3 biologics at once. It would be more common to switch one of your two biologics for an anti-TNF - so you'd be on Remicade + Entyvio or something like that.
05-15-2019, 08:23 PM   #9
John Doe
 
Join Date: May 2019
I have tried Tacrolimus and it didnít work. I guess a swap for a tnf might work so thats definitely one option. My gi said other steroids donít work for my disease location I used iv Flagyl for 3 months then pills for a month with no benefit. I never asked my gi if they have someone on 3 biologics but I donít see why insurance wonít cover it. I probably cost them more money when I end up in the hospital for months at a time. Given that it only took 3 days to approve stelara and 2 weeks to approve Entyvio as a second biologic I can not believe you waited 8 months. That sounds like torture.
05-15-2019, 08:51 PM   #10
Maya142
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It was awful for my poor daughter. She waited so long before it was approved. She was in so much pain.

Since you've tried everything else, maybe they will approve it. I'd just expect needing to appeal to make it happen. We had appealed several times, did a peer to peer review and then it went to an Independent Review Board and was approved. It just took a LONG time for everything to happen.
05-15-2019, 09:27 PM   #11
John Doe
 
Join Date: May 2019
Wow thatís very sad to hear is she doing well now with 2 biologics? I would probably have ended up with surgery if I had to wait 8 months I have also been in a lot of pain and I know two biologics definately work better than 1 as I failed both independently and gave them each long enough time to work. Iíll probably ask my doctor if she is even willing to do three I just thought Iíd ask here before and see if anyone has done it before. I didnít realize two biologics is so hard to get for some people I think it would probably help so many who failed individually.
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