• Welcome to Crohn's Forum, a support group for people with all forms of IBD. While this community is not a substitute for doctor's advice and we cannot treat or diagnose, we find being able to communicate with others who have IBD is invaluable as we navigate our struggles and celebrate our successes. We invite you to join us.

Combining Biologic Treatments

Hello.
I am new to this forum.
I was diagnosed with Crohn's in 2005.
However, upon historical reflections, I have probably been dealing with the symptoms since I was in my mid 20's. I am currently 54.
My first course of treatment was 6mp and Pentasa. I was on that course for almost two years. I have 2-3 flares that put me in the hospital.
My doctors decided that course was not effective and moved me to Remicade infusions. I continued to have flares for the next 2-4 years.
They then decided to move me to Humira.
I continued to have flares which resulted in hospital stays every 8 to 12 months.
I then had some extremely major pain issues that prompted surgery. They removed the most distal portion of my terminal ileum and a portion of my right ascending colon.
After surgery they placed me back on Humira.
13 months after my surgery I had another flare.
They did a colonoscopy and examined the surgical site and noted three moderate indications of inflammatory involvement. As a results they felt the Humira was ineffective.
They consulted a new doctor who specializes in Crohn's exclusively and she suggested Entyvio. I have been on Entyvio along with Imuran and Folic acid since July of 2015. From a Crohn's perspective I feel great.

However in February of this year I began having a variety of join pains and effusion. My right ankle, my left knee, my left index finger, a left intercostal-sternal join, and most recently my lower back and neck.

I have been seeing a rheumatologist since then. Because there is nothing that even remotely suggests combining biologics, he has been treating me conservatively. Sulfasalazine, higher dose of Imuran. Both have been ineffective. He suggested today that I might want to consider doing something no one will even consider. Combining biologics.

He is suggesting that I consider returning to Humira in a lower dosage initially every two weeks. But, he cautioned that he is not aware of anyone that would even remotely consider this.

I am not afraid to blaze a new trail, but is there anyone that knows anyone that is living on the edge and trying things that no one thinks should be tried?

My ankle and my knee problems are affecting me daily and I am running out of options.

I am welcome to anyone's opinions and cautions.

Thank you!
 

Maya142

Moderator
Staff member
Hi and welcome!

I am going to tag Clash because her son's GI is considering this.

My daughter's rheumatologist is also thinking about this. She has Ankylosing Spondylitis and Crohn's. She's on a biologic for her AS that does not work for Crohn's. Her Crohn's was in remission when we switched to it and we hoped it would stay that way. We added Imuran for the Crohn's but within 4 months, it flared anyway.

Now we are stuck - her AS is doing better on this new biologic (Cosentyx -- an IL 17 inhibitor) but her Crohn's is causing problems. Right now I think we will try increasing her Imuran dose, but if that doesn't work, her rheumatologist suggested adding Cimzia.

My older daughter's rheumatologist has also combined biologics -- Entyvio and Simponi (the Simponi was a low dose) for a patient with Crohn's and AS.

We are very wary because of the infection risk, but if it's what we have to do, I guess we'd try it. I don't even know if insurance would allow it.

Let us know if you try it!
 
have you ever tried any diet modifications? it might make your meds more effective. Like Specific Carbohydrate diet? I can recommend something for you to try as well message me if interested.
 
Last edited:
My son has CD and JSpA (juvenile spondyloarthropathy). He has been on remicade then added methotrexate. This did not stop his CD. He required surgery then was started on Humira with methotrexate. His CD is still active.

So we are in the process of decided on the next step. The GI has suggested entyvio and humira. The rheumatologist isn't as on board so we are now considering trying stelara first since studies going on now are showing higher doses are treating the CD well and there has been a study that has shown that it helps with joints.

The GI said if stelara doesn't work he'd be more comfortable with switching to entyvio and adding adding a biologic than doing a combo of say stelara and humira. This is because of the mechanism by which entyvio works and how it differs from tnf inhibitors or IL inhibitors. (That's a very basic explanation)

I will say neither biologic helped my son with his joints until we increased the dose of mtx injection. So, at least for his wrists, knees and ankles I think the mtx really helped. It has helped some with his lower back but not completely.

Also, even though combining biologics isn't the norm there is actually a med in the research pipeline right now that is essentially a combined biologic. The mechanism works on two different aspects.

You could have your GI or rheumatologist contact one of the top treatment centers to discuss this possible route to see if it's in use and what protocols they are following.
 
Top