Building up immunity to meds?

[Ian]

I know a lot of people have experienced medication not working after a period of time, but is there anyone who hasn't experienced this? Or anyone who's found that a break from a medication allows for your body to respond to it when you try it again?

My Doctor doesn't seem to think there's evidence to suggest the immunity thing happens, but users of this forum are my evidence. It hasn't actually happened to me yet, it's just something I fear will occur in the future. I got to thinking about it because I started Humira a week ago. I'm on 6MP and Asacol but started experiencing a flare of my CD and we wanted to avoid Pred this time (Pred does normally work though so I do still have that as a back up).
But I had a 3 infusion course of Remicade early last year to get me out of a very bad flare, and while it worked a treat I now kind of wish I'd been prescribed it as more of a maintenance drug (infusions every 8 weeks), because people say it stops working, particularly if you stop using it and then try it again later! I don't like to think I've already exhausted one of the big guns by only using it once... :/

I also keep thinking that I should have just used Pred for this flare to save Humira for later (in case that one also has a life-span), because it isn't a bad one at all. I used Remicade to get me out of a 9 day stay in hospital (was too far gone for Pred to do the trick and Hydrocortisone didn't work either), but I wouldn't even say I'm unwell this time... I'm in no pain, I'm not tired or nauseous, and only having about 2/3 bm's a day (only 1 today! Maybe it's already starting to work). The only trouble is it's practically liquid and there's blood in it - but I'm taking iron to counteract it so I'm not even getting anaemic this time! I am about 5 months from finishing my University degree so my Doctor felt it was very important to nip this flare in the bud, and I agree. But sometimes I'm like 'Humira? REALLY?!...'. I don't want to waste a good drug on what is currently a very minor flare.

I have no idea why I've suddenly started worrying about it. I just don't want to have exhausted all medication possibilities before I'm 30 I guess!

 

[effdee]

Once your immune system is exposed to it, it can be easier for your body to recognize and kill the biologic in the future. That being said, there's a chance that it will still work for you. There's also a chance that you would have become immune to it even if you stayed on the 8 week dose.

Does your doctor like to discontinue medications once your symptoms subside? Mine always says he does, but we always did so cautiously to try and ensure I stayed in remission. My doctor wouldn't discontinue any of the biologics, though, unless I was switching another one. The side effects of the biologic seemed worth the benefit to me. Being in college, as well, I definitely wouldn't hesitate to use one of the biologics, especially if it allowed you to finish school.

Consider the effectiveness and side effects of prednisone and the biologic. If it isn't much of a flare, I'd give prednisone a reasonable shot as long as the dose stayed low enough. If the flare is bad enough to warrant more prednisone, I'd go with the biologic. Hope this helps!

 

[Ian]

Thanks for the reply

Well actually, in retrospect, having 8 week Remicade infusions wasn't an option at the time. I had it over the course of Feb and March, and at the time NICE (National Institute for Health and Clinical Excellence) were only allowing the drug to be prescribed to treat acute symptoms. Since then things have changed and you can now use it as a continuing maintenance drug, but I remember now this wasn't the case at the time. So actually my Doctor didn't have any choice - the first batch of infusions worked, I no longer had symptoms, so I wasn't entitled to stay on it. I had no problem with this and still don't, I just hope Remicade will work if/when I try it again to treat a future flare!

As for Humira, I've already started it so I will have to continue with it. I think my Doctor said I'd only need to take it for 3 months if things are normal then, which fingers crossed they will be - I've only had my first injections so far (my next one is this coming Friday) and in under 2 weeks I've already improved and wasn't suffering too much to begin with, so I haven't got far to go to be normal again. Low doses of Pred have never worked for me, I always need to start at 40mg, so I'm definitely dodging side effects by going on the biologic.

But you think I should stay on the Humira indefinitely until it stops working? (if it ever does?) I'm on 6MP and Asacol too, and I think I'll ALWAYS be on the Asacol at least, because it has no side effects and totally drug-free remission doesn't seem to last for most people. But Humira is expensive, I can't see him keeping me on it if he doesn’t think I still need it. And I'm fine with that, but like with the Remicade, I want it to work a second time if/when I need it! If stopping taking it that is likely to reduce it's chances of working again, I don't want to stop taking it, especially if it turns out I’ve already exhausted Remicade.

Sorry, I know I’m just creating paranoid ‘what if?’ scenarios here, but based on what people are saying they don’t actually seem all that paranoid.