Can you quickly switch from one biologic to another?

[Ian]

I'm on Humira but it's not helping yet. I may well get hospitalised in a couple of weeks time if things don't improve or they get worse. The last time this happened, Remicade was my rescue drug after Hydrocortisone failed. If Hyrdo failed again, would they be able to try Remicade again? Or are you not able to make a sudden switch from one biologic to another?

I didn't get a chance to ask my doctor this question and I know it's going to bug me now lol.

 

[katiesue1506]

Yeah, You can, usually you can take your dose on the day you would've taken your next dose of the first biologic. So if you're on biweekly Humira you'd take it two weeks after your last dose. I was able to reintroduce Remicade a second time without an allergic reaction but it didn't last long because I had built up antibodies.

 

[ameslouise]

It is my understanding, like Katiesue said above, that if you stop Remi and then start up again, there is the risk that you have built up antibodies. Same thing happened to me, but it had been many years between Remi doses, 7 years I think.

Hang in there, Ian. Fingers crossed for you that you see improvement over the next couples weeks!

- Amy

 

[Ian]

Thanks guys.

Yeah I've read about developing antibodies. When I had it last year, I had 3 infusions over an 8 week period and a few months later I started 6PM. I've read some things about the risk of developing antibodies being reduced if you have a second infusion within 8 weeks of the first and if you introduce an immunosuppressant - I did both of these. But I don't know how much merit there is to these theories.

But if there are no risks to quickly swapping from Humira to Remicade, I hope it would at least be attempted before resorting to surgery, even if its chances of being successful are lower the second time around.

I know Amy, getting ahead of myself as always But I don't have much faith that my cocktail of drugs is going to improve things - I introduced the Pred 2 weeks ago and after 3 days of improvement the blood returned, and I'm still getting blood; not good

I was having a good day before the hospital visit; slept well the night before and passed very little blood. I wondered if I was improving. But the scope revealed just how inflamed I was and made me change my mind... and since then I've felt rough. Haven't slept much and had to get up early to pass blood after not having much of it yesterday. It could be because the scope aggravated things, I don't know, but I'm struggling to stay positive. I don't think my sigmoid colon is long for this world! But you've been through so much worse; I shouldn't complain really!

Sorry about my constant rambling

 

[Dexky]

Hey Ian, I don't have any idea on your question, I'm just curious why you came off the Remi the first time?

 

[Ian]

Hi Mark,

At the time, Remicade couldn't be prescribed as a maintainance drug (8 week infusions). It was only available to treat acute symptoms. They tried it in hospital after IV Hydro didn't work and followed it up with an infusion 2 weeks later, and another one 6 weeks later. Since I was then on my way into remission and had no acute symptoms, I wasn't allowed any more.

Things have changed now though, 8 weekly infusions are now available. However I'm on Humira instead (I think because I split my time between home and Uni so they thought Humira would be more practical - also it's cheaper). I really hope I can try Remi again if I need to, and that it still works...

 

[Dexky]

How long ago was that? I guess they just didn't know what they do now! It would suck if they ruined your chances with Remi! I hope it's not the case. Good luck!!

 

[Ian]

It was only a year ago. Not encouraging that this sounds like it was a mistake lol...

 

[Dexky]

Can you ring or e-mail the GI and get his thoughts about it?

 

[Ian]

I'll be seeing him soon so I will ask then.

I know it wasn't a MISTAKE as such, because NICE (National Institute for Health and Clinical Excellence) weren't allowing it to be prescribed on a perminant basis when I had it. The 3-infusion course was the only available option at the time. I know it can be prescribed again - whether or not it will work (antibodies) is a different matter.

What I'd REALLY like to know is if he will actually try it this time (as a rescue drug) since I'm now on Humira. But since I don't need this information right now I can wait until I see him. I'm getting ahead of myself. It's a thing I do

 

[katiesue1506]

My first GI took me off of Remicade to "try out" Humira since it was so new. My second GI said that was a complete mistake because that's how I formed the antibodies against the second time around in which I was prescribed Remi. I'm now back to Humira. I wish I hadn't switched in the first place because Remi was a life saver. And actually it did just as well the second time, but it was only good for 5 weeks at first, then 4, then 3. Finally I got to where I was taking double doses every 5 weeks. It just wasn't doing anything.

 

[Ian]

katiesue,

That really sucks, sorry to hear that Is Humira not working as well as the Remi was? Sounds like I could be in a very similar situation!

At least mine isn't due to my GI messing up; it's my understanding that he wasn't ALLOWED to prescribe it once I no longer had accute symptoms (UK is/was different to the US - we don't even have Cimzia yet!). I'd be pissed off if I was in yours shoes; if it ain't broke don't fix it!

I wish they'd find a viable way to destroy the antibodies and make people med-responsive again. I know some forms of chemo work (as in the stem cell treatments) but that might be a bit extreme just so that someone can have Remicade again...