How to decide which biologic to take?

[nofun]

Entyvio stopped working for me and it was recommended that I try a different biologic.

The Doctor recommended Humira, Stelara or Skyrizi, but he was opened to try other biologics as well.

How do you compare them to pick the one that is best for you? Is it just a try-and-see method or do you recommend going through clinical studies results to see which one has less side effects and better success rate?

 

[Scipio]

In no particular order, here are some general impressions of the possible candidates:

Remicade: proven effectiveness in closing fistulae. (Do you have a fistula?). Perhaps the strongest overall at controlling Crohn's, but also the most immunogenic - likely to trigger anti-drug antibodies.

Humira: Similar to Remicade but perhaps not quite as effective in some patients. Also commonly triggers antibodies.

Stelara: Rising in popularity. Not quite as effective as Remicade and sometimes takes longer to work, but it works pretty well for a lot of patients. Often does not trigger any antibodies and thus may not need to be combined with azathioprine or methotrexate to knock the antibodies down. May work better on small bowel disease than on colonic disease (Where is your Crohn's located?) Works by a completely different mechanism than Remicade or Humira.

Skyrizi: Similar mechanism to Stelara, so it may act similarly. Too new to say very much about. I don't yet know anybody who has had it.

 

[nofun]

I don't have fistulas and my Crohn's is located in the large intestines. Do you know how Entyvio compares the the others in terms of how it works? If it stopped working for me maybe I should try something that works in a different way.

 

[Scipio]

Entyvio is unique in terms of its mechanism of action. So any of the above medications would work in a different way. Entyvio is thought to work a bit better in the colon than the small bowel, which is perhaps why your doc started with it. Too bad it has stopped working for you.

 

[momsa]

This seems to be the million dollar question. Isolated colonic Crohn's here too. So far Stelara and Entyvio have had some effects but not enough. The next options are Humira, Remicade, Skyrizi. Interestingly, some researchers and docs think that Skyrizi might work even for some that failed Stelara. But yes, it is early.