Flare after 6 month of succes with Humira, what's the next step?

[Lady Organic]

Hey guys,

I entered full remission very rapidly in last January fallowing my first shots of Humira. Unfortunately, since a week, I notice a return of symptoms and I can now confirm its a flare in the rectum again. I will call my IBD team leater today to let them know.

I have read Humira can be upped to 1 shot a week instead of 2 and I guess that would be the next step?

Efficacy and Safety of Escalation of Adalimumab Therapy to Weekly Dosing in Pediatric Patients with Crohn's Disease

The efficacy of adalimumab in inducing and maintaining remission in children with moderately to severely active Crohn's disease was shown in the IMAgINE 1 trial (). As per protocol, nonresponders or patients experiencing flare(s) on every other week (EOW) ...

www.ncbi.nlm.nih.gov

I guess my GI will want to check for antibody and serum level of Humira? I have never been tested for these values yet.

I am also taking a bit of 6-mp which I had decreases slowly in the last months (GI's recommendation). My GI doesnt like I take 6-mp along with Humira since I had laser surgery for cervical pre-cancer lesions a few years ago. I decreased it but not enough to cause a flare imo. ( I was already in a flare while taking it anyway, prior to starting Humira). I doubt the 6-mp is in cause here, but who knows...

Having a weekly shot of Humira scares me for side effects, short or long term...
I wonder if it would be best to try another biologic instead?
Any thoughts?

 

[my little penguin]

That’s tough
Depends on your levels
Ds was given humira
Every 14 days
Then every 10 days
Then every 7 days and lastly every 5 days

In his case the humira would wear off prior to the next shot
Which is different than getting no relief from the meds

Other option would be Stelara
Low infection rate
Given at home. And different mechanism
Since anti tnf didn’t last long for you

 

[crohnsinct]

Sorry you aren't feeling well.

There are studies that say the risks and side effects with the anti tnf biologics (Humira and Remicade) do not increase with dose optimization. I think I posted those studies in the parents section.

Hopefully it is just a function of the drug not being at therapeutic levels and you just need to move the schedule a little tighter.

My daughter has rectal and colonic disease primarily and her doc moved to Entyvio after anti tnf failure because in his experience it has better success rate than Stelara in those areas. However, she does have some TI involvement and isn't intermission yet so maybe Stelara is our next try.

 

[Mountaineer01]

Sorry to hear the Humira doesn't seem to be working any more. Crazy question - have you had any tests done to confirm it is a Crohn's flare? The reason I ask is because we are conditioned to think it's our Crohn's acting up when it could be something else simply because it's been the usual culprit for years.

About a month ago, I was worried I was going into another flare even though I've been on Humira for about 9 months. Had all the classic symptoms and they didn't let up. Come to find out, it was a bacterial infection that most likely came from tainted lettuce. Two weeks' worth of antibiotics and I was feeling like myself again. My GI doc reminded me that being on Humira makes us more susceptible to things we may normally be able to fight without symptoms. I never did eat them much, but I've now sworn off salads for good unless my wife makes them and I know the produce has been cleaned thoroughly!

 

[Lady Organic]

Thx very much guys for your replies.
I called my IBD nurse. GI is on a leave from work Will probably be back in August... There's another GI taking patients in the meantime, but the nurse and I have agreed that I would take cortison enemas for a couple of weeks and wait to see my GI when he comes back. Thanks Mountaindeer01 for the though, but yes, I am 100% sure its a flare. I get a little bit of mucous and micro bits of blood inside the mucus, which is classic sign of disease activity for me. Its been years with the same scenario Ive seen blood 3 times over the last week, so it makes it clear for me. At this point, the activity is very mild, debuting and I probably have just a few centimeters inflammed in the rectum. The enemas will clear this rapidly, as it usually does and I should be good for at least 2 months.

Now I wonder if I could take those Humira levels right now and be prepared for my dr's return. How is this done? Its a blood test? Maybe the replacing GI could prescribe it if the nurse cant.
Is the test to be done on the days prior to the injection day?
I would like to know more about it please.
Do we also have to take a test for antibodies?
Thanks again!

 

[crohnsinct]

The levels and antibodies test is usually done at the same time with the same blood sample. Yes, you usually do it on the day of the injection so they know the absolute lowest level. I would also ask for a fecal calprotectin test. You are seeing some signs of your usual inflammation but this might tip you off to inflammation further up that maybe you are not yet seeing signs of.

I hope the enemas work as quickly and as well as they have in the past and that the GI filling in can order those labs for you. Good Luck!

 

[Lady Organic]

Thank you very much! I will call back the nurse and suggest those labs and calpro as a preparation. My next injection is in 11 days.

 

[MikeinBklyn]

I've been on H for a long time, 9 years. And yes, flares still occur a few times during the year. I'd say stick to Humira and see how you do.

Good Luck

 

[Gabriel89]

I had exactly the same thing, was on Humira every second week since last July, now on every week. For me it helped somewhat.

They increased due to calprotectin levels.

 

[Dyana]

My 1st biologic was Humira with very low Aza to help fight antibodies, When it appeared to not work as well it originally did. They took an antibody test. Here they send the blood to prometheus labs in California- the test is not covered by my insurance. I paid $250 each for 2 tests. Antibodies were found and I was moved to Cimzia also with aza- very short term as it effected my joints and caused RA like symptoms. Next came Remicade also with low dose aza and it has worked for 2 years- less effective now- so they took the antibody test.(expect another $500 bill soon) No antibodies found so they just reduced dosage period from 8 weeks to 6 weeks. So the antibody test is useful and there are other biologics that may work better for you. just something to consider. good luck- Dyana

 

[Lady Organic]

Thank you guys for your replies.

Got a call from my nurse today.
the calpro 900 confirmed my relapse (quite surprised with this very high number) and my Humira level is very good at 30.
GI wants to wait another 3 months to see how it goes and tells me not to discourage, that Humira can take more than 6 months to be fully effective.
So I continue the cortisone enemas and the purinethol along with the Humira, and wait and see.
Im still in a very minor flare, no GI discomfort or troubles.
I big stressor in my life has just ended yesterday. Hopefully feeling more relaxed will help the Crohn's.

 

[my little penguin]

Glad you have a plan
Hope it kicks in soon