Combined treatment with Humira & Stelara

[Jandersen20]

Quick question. If taking both Humira & Stelara for Crohn’s, how do you space the time between the 2? How many days between the 2 biologics.? All I’m wondering about is how many days between.

Thank you!

 

[my little penguin]

They don’t combine two biologics for the same disease except on very very rare occasions after you have exhausted all other meds .
Most insurance companies will not cover two biologics especially for the same disease .
There are multiple warnings in not giving Stelara with humira .
It suppresses the immune system too much .

my child is on two biologics but for different diseases so different pathways
Even then it’s a fight to get insurance to cover it .

Has the Gi already suggested adding Stelara to humira ?
I thought he just upped the frequency of humira ?
What were his humira levels at the higher frequency?
Normally you add methotrexate to humira if higher frequency does not work
Then
Most do bloodwork/imaging /scopes after increased frequency and adding immunosuppressants to prove the med failed .
Then and only then do they switch biologics
But they do not put them on two biologics at the same time .
It’s a long drawn out process of many months

 

[Jandersen20]

Doc upped Humira to every 10 days in December. Still having bleeding, urgency, and frequency, although all have slightly improved. Fecal calpro just came back at 1430. Doc was very disappointed. Since his fecal calpro is still so high after upping Humira frequency and after a 6 week course of Uceris Foam, she would like to switch to Stelara.
I need to clarify: She’s not having him do both biologics, but he still has 3 Humira pens left. So she said to set up the Stelara infusion and still finish the Humira. They can’t be done within 24 hours of eachother, but didn’t give a prime space between. So I’d just like to know how many days I should leave between his Humira dose and first Stelara Infusion. Hope they makes sense.
Thanks!

 

[my little penguin]

If your humira dosing is every 10 days then you do the Stelara infusion 10 days after the last humira shot .
Ds was on humira every 5 days and we did Stelara 5 days later .
But Stelara takes months to work so you need a bridge therapy of steriods until it kicks in

 

[Pilgrim]

We were allowed to wait longer, it was a few weeks. We had been dosing 40mg Humira every 7 days. But her Humira levels were VERY high and she was having some side effects. When we started Stelara we did strict CDED diet for 12 weeks while we built Stelara levels in her system. This was ok'd by GI.

 

[Poppysocks]

They don’t combine two biologics for the same disease except on very very rare occasions after you have exhausted all other meds .
Most insurance companies will not cover two biologics especially for the same disease .
There are multiple warnings in not giving Stelara with humira .
It suppresses the immune system too much .

my child is on two biologics but for different diseases so different pathways
Even then it’s a fight to get insurance to cover it .

Has the Gi already suggested adding Stelara to humira ?
I thought he just upped the frequency of humira ?
What were his humira levels at the higher frequency?
Normally you add methotrexate to humira if higher frequency does not work
Then
Most do bloodwork/imaging /scopes after increased frequency and adding immunosuppressants to prove the med failed .
Then and only then do they switch biologics
But they do not put them on two biologics at the same time .
It’s a long drawn out process of many months

I've heard of people being on stelara and entyvio at the same time. But not stelara and remicade or stelara and humira.

 

[crohnsinct]

What was the GI's reason for not trying every 7 days with Humira? What were his Humira levels?

Uceris foam will not heal Crohns that causes bleeding. IT only treats the top layer so will alleviate the bleeding but doesn't reach deep enough to stop the cause. So generally, after you stop taking the foam or for some even when taking the foam you will still have bleeding.

 

[Maya142]

2 biologics at the same time are really a last resort. But if I'm understanding correctly, your doctor is not saying he'll be on both - just to finish the remaining doses of Humira before moving on to Stelara? That is unusual. My daughter has been on MANY different biologics and once we get a new biologic approved, we start it - we don't continue with a med that isn't working. Typically it's one dosing cycle - so my daughter was on Humira every 7 days when we switched to Remicade - we just did the 1st Remicade infusion when the next Humira shot would have been due (7 days from her last Humira). It did mean we had several extra Humira shots left in the fridge - I always keep them until they expire.

Sometimes we don't even wait that long - as soon as the new drug is approved, we switch to that (with the doctor's permission). For example, I remember switching to Simponi about 2 weeks from her last Remicade infusion, even though she was getting Remicade infusions every 4 weeks. Her GI was not at all worried.

I'm also kind of surprised your GI is not exhausting Humira as an option before moving on - there are only essentially 4 biologics for Crohn's, so you want to make sure you do everything you can to try to get Humira to work before switching. Normally, you'd increase Humira to weekly and you could also add MTX. And often you'd also try a steroid or EEN, to induce remission while you're waiting for Humira to work.

 

[Jandersen20]

We’re waiting to get Stelara infusion set up. So in the meantime, she told us to finish the Humira.
The reason she wants to switch to Stelara is because even on Humira every 10 days, his fecal calpro is 1430, and she doesn’t think an adjustment of Humira again would provide an enough of an added therapeutic benefit as starting Stelara. She’s the expert, so trying to trust.

 

[Pilgrim]

That was our situation. Be patient. For us the Stelara took many months to kick in and it's still not perfect. We've had to add EEN for 6 weeks recently and last April we did strict CDED for 12 weeks and both things helped Stelara work (or maybe just helped in general). I've had more than one doctor say it's a safer drug than the anti-tnf's.

 

[Jandersen20]

That was our situation. Be patient. For us the Stelara took many months to kick in and it's still not perfect. We've had to add EEN for 6 weeks recently and last April we did strict CDED for 12 weeks and both things helped Stelara work (or maybe just helped in general). I've had more than one doctor say it's a safer drug than the anti-tnf's.

Thank you @Pilgrim. I appreciate your response!

 

[Maya142]

We’re waiting to get Stelara infusion set up. So in the meantime, she told us to finish the Humira.

That makes much more sense! Yes, generally you can just schedule his infusion 7-10 days out from his last dose of Humira. Hopefully it will be approved soon.
I would prepare him for steroids though, since Stelara takes months to kick in. Or EEN, if he's willing to do that. Stelara is less immunosuppressive than anti-TNFs but it takes much longer to act - all the IL-23 inhibitors do (there are several in trials for Crohn's and UC).