Antibodies

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Jun 4, 2012
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Have any of your kiddos developed antibodies towards Remicade? If so, what was your next step? My son just had his fourth Remicade infusion last Wednesday and I thought he would have felt a little better and going to the bathroom a little less. There is a new test now that tests the exact amount of Remicade in the body and if the body has developed antibodies. My son is having this test done so hopefully we get good news with the results later this week. I'm trying to stay positive, but on the other hand, nothing has seemed to go our way with luck since his diagnosis so I am nervous.
 
My daughter had quite a few of those tests done while they were trying to get the correct dosage and schedule. If he still has symptoms it could be he is metabolising the Remicade too quickly and just needs a higher dose and shorter interval. My daughter is on max dose and 5 weeks. Although come to think of it...she usually got better and then symptoms appeared at week 3 or 4 so maybe since he hasn't gotten better at all he is developing antibodies and I have just muddied the water.

Oh wait...another discussion we had with the doc when it looked like Remicade antibodies were not building but that it simply wasn't working all the way was adding another drug...Methotrexate was doc's choice. Enteral Nutrition was my choice. We did 6 weeks exclusive EN and that got my daughter on her way.

There are a few others here whose kids developed antibodies...they should be along shortly.

Good Luck!
 
Yes, Alex built antibodies to Remicade. He wasn't doing regular testing of his blood levels of Remicade, only general monthly monitoring liver and sed rate levels. I've heard recently that adding 6mp or mtx helps avoid building antibodies to it, Alex was on remicade only. He didn't bounce much, if at all, at his last infusion last Dec, then was sick with a virus in Jan and his inflammation jumped up. So, we tested him for antibodies because he was having a lot of stomach pain and found out. He started Humira in Feb and it's going well. Not quite the energy bounce as Remicade and his protein is still low, so we added 6mp last month. I hope it lasts longer for your son. Hang in there!
 
Yes, my son is on remicade right now. It wasn't working after 3 doeses and he had started building antibodies, so they added methotrexate injections and now it works. I know that our time with this drug is limited. The GI has mentioned Humira as our next step, but I don't know what it really will be just yet. We are having a new HACA/remicade level test done next week. Prometheus labs actually sends someone to our house to draw the test and the results come back in 3 days. Bad news is insurance doesn't cover.

If he isn't on methotrexate, that should be your next step. It slows down the antibody-building process. Not perfect, but it lenghthens the remicade time. Methotrexate is better than 6mp because of the 6mp/remicade risk of lymphoma, especially in boys.
 
Ah thanks jmk I was wondering about that and fixin to pm you. Does adding the MTX just slow the building of antibodies or can it reverse or halt it altogether?
 
One thing to remember all of the orig studies were done with Remicade and 6-mp so lots of Gi followed that protocol at first since t cell lymphoma was not discovered in the orig testing or trials. Now since Mtx follows the same mechanism as 6- mp and Imuran the odds are good the same risk is involved. Unfortunately since the risk is rare with 6-mp to begin with it will take time and lots of gi's prescribing Mtx + Remicade to know for sure if there is an increased risk. There have not been large enough sample studies yet on this combo to determine if there is a risk.
Not sure how we will handle this one I flip flop each day.
So Remicade only
 
MLP I agree not enough testing yet but I did read on a medical link, not sure if I can find it again, that although the studies have shown the lymphoma risk in the 6MP/AZA remicade combo in JRA or RA patients the risk hasn't shown up in MTX/Remicade combo and RA docs have prescribed that combo much longer than GI docs. Another article explaining the same things stated that back when these drugs were decided upon for use in diseases like RA and Crohns, alot of RA docs took the mtx route and GI's took the 6MP/AZA route and that GI took longer coming around to MTX than RA's took to start using 6MP/AZA.

Ok, I just read through that and if you can follow my jumbled train of thought then you deserve some kind of award. My mind is just a blur right now!!:ywow: Anyway, if I can find the articles again I will post them and it might shed light on what I so poorly tried to say above!:blush:
 
Clash, I got what you are saying! My mind's a blur too, so maybe that's why!

The methotrexate...I think it just slows down the antibody process if it has already started. I don't think you can reverse it and it will probably continue to rise, only at a slower rate. Ryan's antibodies getting to 5.6 after only 4 doses was very high. Remember he was only taking half the therapeutic level then too. Now he's on a full dose, so we will see...

Unfortunately, we are often left with a 'lesser of two evils' choice with this disease. I fought mixing the two drugs. But the GI made me realize the damage happening now was just as dangerous as the possible side effect of the drugs. Poo! Poo on Crohn's!
 
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