First treatment given?

[Clevelandnative64]

I have an appointment with my g.i. to discuss treatment options after i was just diagnosed with crohns. I have fistulas and moderately severe disease in my colon and small intestine. I was thinking of starting biologic therapy right away, so i wanted to know if doctors do that as fist line therapy? I also have pyoderma gangrenosum(had for 8 years before crohns showed up) which makes it a little more complicated, especially since i can no longer take steroids due to the glaucoma it caused. I was also thinking of combination therapy, What drugs do they give you with humira? I am severely allergic to sulfasalazine so i cant take that and i read 5-asas are about as effective as a bandage. So, really what i want to know is what should i expect as the first medications given?

 

[ronroush7]

It might be a consideration since you are moderately severe. I am not sure though.

 

[Maya142]

It really varies - it depends on your condition and various factors (what kind of IBD, where it is located, how aggressive, your age etc).

I would guess that since you already have multiple fistulae and pyoderma gangrenosum, they'll probably go with a biologic to prevent more complications. Now more and more doctors are using "top down" therapy - starting with the drugs that work best, to get the disease under control quickly.

They will also often start an immunomodulators at the same time - something like Methotrexate or 6MP/Imuran to stop you from building antibodies to the biologic and for additional disease control.

Other doctors still use the "step up method" and start with the mildest meds - Pentasa or other ASA (which don't do much for Crohn's), then immunomodulators and then if you fail those, biologics.

The biologics mostly commonly used are Remicade and Humira (anti-TNFs). Entyvio, Cimzia and Stelara are also approved for Crohn's.

 

[my little penguin]

http://emjreviews.com/wp-content/uploads/Pyoderma-Gangrenosum-A-Mini-Review.pdf

Article on PG
And a lot overlap with ibd biologic meds
Might be worth asking about

 

[Ricky_V]

With Fistula's, I would probably go with Remicade plus an Immunomodulator. From my reading Remicade seems to be popular approach to healing Fistula's. Fistula's are not good so don't waste any time getting on Meds.


I am not a Doctor... just my take

 

[Clevelandnative64]

thanks everyone, ill talk to my doctor about humira and combination therapy

 

[crohner000]

I started with Remicade and had a really good experience before developing antibodies after a couple of years on it. I also had a fistula when I was diagnosed and the Remicade helped it, didn't have to have surgery.