Humira antibodies

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WiscoMom

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I think I've read just about every thread on this forum since my son was diagnosed with Crohn's disease 2 years ago, and it's been incredibly helpful. I think this is the first time I couldn't find a similar scenario to our current situation, so here goes: my son is 17, and after diagnosis 2 years ago he started biweekly Humira, and went into remission within a few months. His main symptoms were diarrhea/frequency, some vomiting, and serious weight loss. He's gained 50 pounds and 2 inches in height, and BMs are totally normal, once a day.

This summer, he had a pretty obvious flare. Weight loss, fatigue, BMs up to 2-3 a day. Our doctor checked his Humira levels and it came back with a trough level of 5 and "moderate" antibodies (she didn't give an exact number). So, she added Methotrexate injections and increased the Humira to weekly. All of his symptoms resolved, he gained 10 pounds back, and actually seems to be doing better than he was on biweekly Humira alone before the flare. After 10 weeks, she checked his levels again, and his Humira trough level is up to 14 (was 5 previously), BUT the nurse said he still is showing "some" antibodies. She wasn't able to tell me if it was higher or lower than the last time, and said the doctor wants to talk to me about it when she is back in town in a couple of weeks.

So now I'm driving myself crazy trying to guess what the doctor might be thinking or planning. If there are still antibodies, does that mean our days with Humira are done, even though his trough level looks good and he is doing great? His fecal calprotectin dropped from 403 during the summer flare to 27 last week, and he has no symptoms at all. All the other bloodwork was normal as well, according to the nurse. I'd love to know if anyone has experience with continuing Humira when there are antibodies present! Thanks.
 
WiscoMom said:
So now I'm driving myself crazy trying to guess what the doctor might be thinking or planning. If there are still antibodies, does that mean our days with Humira are done, even though his trough level looks good and he is doing great? His fecal calprotectin dropped from 403 during the summer flare to 27 last week, and he has no symptoms at all. All the other bloodwork was normal as well, according to the nurse. I'd love to know if anyone has experience with continuing Humira when there are antibodies present! Thanks.
Click to expand...
No symptoms
Blood work normal
Humira = 14
FCP = 27
These are all really great news.

For that reason I think it is very unlikely that a GI would change medications when the drug level is high and the patient is doing so well (no symptoms). The rule of thumb is that the first biologic that a doc tries for a given patient will be the best one. If forced to switch the follow-on biologics probably won't work as well and last as long as the first one did. So most GIs will battle to hang on to that first biologic for as long as they can.

Since your son is doing so well, I suspect you are just seeing a little residual antibodies that aren't really getting in the way of the drug. The GI may adjust the immunomodulator dose to try to knock it down, or maybe not even that. S/he may just do nothing for now and see how it goes. If it ain't really broke, don't fix it.
 
Thanks! You make an excellent point as far as sticking with the first biologic you try for as long as possible. I really hope that's what his doctor has in mind considering how well he's doing.
 
Hi and welcome (though sorry you have to be here)!
I agree with the above response - I really think you might be ok, though perhaps your GI may want to up his MTX dose. Or she may just want to check in just to see how your son is doing, since he does still have some antibodies. My daughter had antibodies to a different biologic, Cimzia, though her antibody level wasn't terribly high (but it was definitely high). We increased her frequency from every 4 weeks to every 2 weeks and her trough level went up and her antibodies went down, although not to zero. We continued on Cimzia for two years after that, if I'm remembering correctly.

When we switched, it was because Cimzia stopped lasting 14 days - it lasted about 9 and then she'd start having symptoms - diarrhea, sometimes up to 10 times a day, would wake up at night to go to the bathroom, had increased urgency, small amounts of bleeding etc. and her arthritis would also flare. Her blood work was not normal (but it never is, so that's not the best example) but her Calprotectin was high, although hers is never sky high.

Your son isn't in that situation - thankfully he is still responding well to Humira and his blood work and FCP are both normal (in fact, FCP is great!!). So hopefully you won't have to make any changes.

I will add, though, that Humira can be given more frequently than once a week - my daughter was on 40 mg every 6 days for a while, another parent's son was on it every 5 days and another parent's little girl was on a double dose weekly (80 mg weekly). So that may also be something your GI may want to discuss.

I'll tag some other parents, some of whom have dealt with this: @pdx @my little penguin @crohnsinct @Jo-mom @Pilgrim
 
Thanks for the detailed response! My least favorite game is "guess what the doctor is thinking?" but I can't help playing it every time I get a shorter than desired message from the nurse! I always want ALL the details right away, and that just doesn't seem to be the way things work. My son is currently on 25 mg methotrexate injections, so I imagine that may be the maximum for that, but there is room to increase the Humira if that would be the direction she is considering.

I just can't help looking at how he seems to be doing since adding the MTX and going to weekly Humira (feels great, gained 10 pounds in 3 months, normal once daily BMs) and wondering why she would want to change anything. But obviously, any presence of antibodies is not good, so maybe there's more that she wants us to be considering going forward.
 
I hate waiting too!

My daughter developed antibodies to Remicade several years ago, after we dropped methotrexate from her combo treatment. After adding back methotrexate and increasing the Remicade dose, her antibody level dropped back down to undetectable. So antibody development is not a one way street that always leads to a biologic switch. Hang in there until you can talk to the doctor!
 
That's interesting to hear! Do you recall how long it took for the antibodies to go down after adding MTX back? My son has been on MTX and weekly Humira for 10 weeks now, and his Humira trough level went from 5 to 14, but I have no detailed level on the antibodies- just "detected" and "still detected." I always want exact numbers!
 
WiscoMom said:
That's interesting to hear! Do you recall how long it took for the antibodies to go down after adding MTX back?
Click to expand...

I just went back to look at her labs from 2016. She had antibodies (low but detectable) on Nov. 30, she started back on MTX on Dec. 2, and her antibodies were undetectable on Jan. 13. She's still on infliximab today, 5 years later, although she's now at the maximum dose and may need to switch to something else soon.
 
Thanks for checking on that! It makes me wonder if our doctor is concerned that he still has antibodies after 10 weeks of MTX plus weekly Humira. I'm trying to feel encouraged that his trough level went up from 5 to 14 during that same time, but I don't know if that makes a difference. It seems to be helping based on how he's feeling as well as his other labs, but I just don't know.
 
The fact that his trough level increased is really a GOOD sign. I also hate the waiting game (and also play "what on earth is the doctor thinking" game - that's quite common on here, as I'm sure you have gathered) but perhaps one day I will learn to be patient (hasn't happened yet 😬, though my kiddos are now both quite grown-up). And I'm also encouraged by the fact that he gained weight and feels well and his labs look good.

Honestly, if it were my child and the doctor came back after seeing those results and wanted to change his biologic, I'd get a second opinion before doing. Because you don't want to run through biologics too quickly - there are really only 4 or 5 used for kids, and so I wouldn't even want to up his dose unless his trough level was low or if he had a lot of symptoms and blood work/his FCP supported that. I'd want to save a higher dose of Humira for when he's flaring instead. Also, you are right that typically not more than 25 mg of MTX weekly is used for IBD.

Anyway, all that said, I'm a mom and not a doctor! But I do think if you're uncomfortable with what your doctor is suggesting that a second opinion is a great idea. A second set of eyes never hurts. But for now, since we don't know what his GI is going to say, I would say do your best not to worry about it. She may just want to check in to see if he has symptoms or if he feels like Humira lasts only 5 days of the 7, for example.
 
You have a good point as far as thinking maybe his doctor just wants to check in on how he's feeling based on the improved trough level and continued presence of antibodies. Nothing seems to trigger my anxiety as much as partial data! I almost wish the nurse had waited until the doctor was back in town to tell me the lab results, but I would have gone crazy waiting anyway. I can't help wondering if there's a chance that the MTX is helping directly with the inflammation with that big of a drop in his fecal calprotectin while he still has antibodies to Humira. I can't find much information on MTX as a monotherapy for Crohn's disease, though.
 
So the mtx boosts humira
So the combo of the two do much better thdd as n humira alone in the higher levels of inflammation.
So once on a biologic one does not go backwards to just an immunosuppressants such as mtx
 
That makes a lot of sense, and definitely fits how our doctor explained it. I kind of wish we'd started with the MTX right away along with the Humira in case it would have stopped him from ever developing antibodies, but the doctor never suggested it when we started Humira. I just can't figure out why the antibodies are still there, but the Humira trough level is way up compared to before adding MTX. I guess the MTX did its job raising the trough level, but not getting rid of the antibodies? I wonder if the antibodies will eventually go down if we stick with the weekly Humira and MTX.
 
You could be my new best friend. I also hate partial data. Hate waiting. Hate missing doc's calls on Friday at 4:50 p.m. that leave you wondering for a whole weekend....heightened when said doc is then out of town for a week! And I especially do NOT enjoy playing out favorite game around here, "outguess the GI".

I will throw one more option for what the GI might want to discuss...the antibodies. If the drug is working, which it seems to be with those results, can I get a woot! woot!...they could be coming up with an antibody plan....ie: with Remicade there is a premedicate with Benadryl, steroid etc option so the kid does not have an anaphylactic reaction. Perhaps, inject in the office a couple of times. etc.

It honestly could be anything from a hey how ya doing check in to I am not comfortable with this level of antibody. Unfortunately you just have to wait, but please celebrate that the drug is working and keep us posted.
 
"Out-guess the GI," I love it! Yes, apparently that is my (least) favorite game as well. I gave in today and called the nurse back to see if I could squeeze a little more information out of her, and I must have caught her in a good mood, because she was able to dig up a bit more detail on his antibodies. Apparently, they are definitely DOWN from August, so maybe in the low to moderate range now instead of moderate to high? Also, we were able to get in for a consult appointment late next week to actually talk to the doctor in person and find out what she is thinking as far as next steps.

Of course, none of this will stop me from playing out-guess the GI for the next 6 days...
 
This is excellent news! I don't imagine the GI has anything sinister to discuss. You can play the game but I am a pro...12 years and running!
 
I'm trying to focus on the potential positive news, but the waiting is always the worst. Today I distracted myself by nearly slicing my thumb off while cutting an avocado and hitting myself in the foot with a sledgehammer while pounding a stake into the ground. Maybe non-stop Googling of medical studies is a safer activity for me!
 
Well, we had our GI appointment today, and the news was mixed but cautiously positive. We finally got a copy of the official lab results, and his Humira trough levels were as we thought: improved from 5 in August up to 14 in November after increasing Humira 40 mg to weekly and adding 25 mg MTX injections. His antibodies are down, but only slightly. From 198 in August to 139 in November. Both are in the intermediate range, which our doctor says is the range where she is okay with a cautious watch and wait approach for the next 3 months until we run all the labs again. Obviously, if any symptoms pop up, we would check sooner. She says that Remicade would definitely be the next option if things take a turn.
 
That sounds like a good appointment! I know antibodies still aren't where you want them to be but you do have a plan B, in case she needs to switch.
 
Yes, I'm trying very hard to focus on the positive for now, which is not always my strong suit. The tricky part for us is that although we know Remicade has a good chance of being very effective if we need to switch, it would be a pretty major challenge for our family to make it work, which is why our doctor has been doing everything she can to squeeze every last bit of effectiveness out of the Humira/MTX combination. We are in a pretty remote northern area, and Remicade infusions would mean overnight trips with hotel stays for us. Not a pleasant thought, especially when you add in our roughly five months of "exciting" winter driving conditions!
 
Most kids and adults can have home health nurse come to your house or Dorm Room to do the infusion
No need to travel
Most insurances insist on that now
So worth looking into
 
I so wish that was an option for us! With my son's history of anaphylaxis (food and medication allergies) coupled with how far we are from medical care, his doctor strongly advised against that as an option if we need to switch to Remicade. As an unfortunate side note, home health nurses are in very short supply up here...the average wait time for new patients is 9-12 months right now. I appreciate the suggestion, though!
 
Ugh ….
Given his food and medication anaphylaxis (my kiddo is the same )
You may want to talk to your Gi about “other “ options

my kiddo reacted to remicade (murine protein -mouse ) -humira is more humanized less likely to react
Docs stated it wasn’t if he would react but when
Ds given his history
He made it 8 months on remicade
Lots of skin rashes
And finally full reaction x2
(Second time they used iv solumedrol and Benadryl -still didn’t stop it )
 
IDK where you live but many of the specialty pharmacy providers have infusion centers now staffed with nurses, pharmacists and medical doctors and they are very capable of handling allergic reactions. You seriously would not be able to tell that you weren't at a hospital based infusion center. Just put that in your hat in case your child has to move to Remicade but for now just enjoy the good news!
 
You could try another injectable anti-TNF - they're used less frequently, but Simponi is approved for UC and Cimzia is approved for Crohn's (in adults, though there have been pediatric Cimzia trials definitely). My daughter did well on Cimzia for almost 4 years (after which she developed antibodies and it would only last for 9 out of 14 days, so we had to switch).

She has also had home infusions - she doesn't have a history of anaphylaxis, but the nurses carry epinephrine and everything else they would need for an allergic reaction. BUT our circumstances are different - we are fairly close to a hospital - about 10 minutes away at most. If he has a history of anaphylaxis and you're really far away from a hospital, it would depend on what his GI/allergist think is safe.

Stelara could also be an option, but as I'm sure you know, it's not an anti-TNF.
 
You all make really good points. The doctor did mention Stelara as a possibility, but seemed to prefer giving Remicade a try first if we need to move on from Humira. I hear rumors that a new pediatric clinic with an adjacent infusion center may be coming to our general area in the next year, so that's hope for the future. As for now, can I just stick my head in the sand and pretend that the MTX will get rid of all the antibodies and that Humira will keep working for the foreseeable future? Uncertainty is my least favorite thing ever, and this disease seems to specialize in it!
 
Hugs
None of us know how long each med will continue to work
And we all dread each med change since your left with the “will it work “ how long till it works “ then “how long will it work “
I get antsy close to 5 years since that is the longest he made it so far (humira )
Stelara he has been on 4 plus years now 🙈
 
You know, in rheumatology, they actually do not test drug levels and antibodies. The reason is that when they did studies, they found that in rheumatology patients, antibody levels did not correlate with whether the drug worked on not. Some patients had no antibodies and failed drugs. Others had high levels of antibodies and the drug still worked. The one exception is Remicade and that's because it's made of mouse protein. But for humanized biologics like Humira, they still do not check drug levels and antibodies. So definitely stick your head in the sand and hope for the best!
Also, if your son is turning 18 soon, then that should give him access to adult infusion centers - even if he's with a pediatric GI. Not always, but sometimes. So there is hope. There was a mom on this forum who always used to say "Don't borrow trouble" - I think that makes a lot of sense (of course, easier said than done, but it's worth a try!).
 
So this was an unexpected development: my son had his bloodwork leading up to his appointment later this month, and after 6 months of adding Methotrexate injections and moving Humira to weekly to try to bring up the Humira trough level and get rid of the antibodies, his trough level went from 5 to 40! His antibodies went from intermediate to undetectable.

So now the doctor wants to stick with the Methotrexate and move the Humira back to every other week. I'm thrilled with the lab numbers, of course, but a little nervous about going back to every other week on the Humira. I've never heard of anyone decreasing the frequency...only increasing. I'm a little nervous that the antibodies (and his symptoms) will come back. Also, I've never heard of a Humira trough level that high.
 
I think your doc's strategy is reasonable. As you say, a trough of 40 is quite high. You've probably got room to give some Humira back, so to speak, and still keep a decent trough. Which in turn suggests that the methotrexate is doing its job quite well in suppressing the antibodies.

But I do think your doc should check his next trough level immediately after decreasing the dose and for several troughs after to make sure that cutting back to every two weeks didn't drop the trough farther than was planned.
 
Last edited:
That's a really great suggestion. I will definitely bring that up at his appointment. The appointment will be nearly 4 weeks after the frequency change. Do you think that is soon enough for rechecking the trough? That would be after 2 biweekly doses.
 
Wanted to add that Humira is metabolized by everyone differently and as your metabolism changes so will the Humira levels. Especially with kids and teens, the metabolism really keeps changing so there are often changes both increasing and decreasing frequency so it is good to periodically have the levels checked.

Also, disease activity will affect how much of the drug clears your system so when in a flare or with high inflammation, much of the drug passes through so you will need a higher dose or increased frequency but then later with healing you might find that you are holding onto the drug more efficiently and so you can decrease dose or move out frequency.

My daughter is on Remicade and her infusion schedule and dosing is a moving target. We are often making changes to respond to inflammation or to make sure we are not over medicating.

Lastly, while the published levels are a very good guideline, they are just that. A general guideline. Some people might do really well at a level of 5 but another just might need a level of 10. I guess this is why they say medicine is just as much art as science.
 
Great point on the metabolism changes, as well as the body not needing as much of the drug in the system once the flare has passed, which (knock wood) seems to be the case. He, of course, is thrilled to only need Humira every other week. He actually prefers the Methotrexate injections. Says they hurt less.
 
Is he getting citrate free Humira? My daughter was only on the old Humira (which burned a LOT) but I've heard citrate free does not hurt much at all.
I wouldn't worry about moving out his doses to two weeks - the doc would only do that if he was doing really WELL! It's scary, of course. But you can go back to weekly if necessary.
 
We definitely have the citrate-free Humira, and he never used to complain about it hurting. I think going from 1 shot every 2 weeks to 2 shots every week since we added Methotrexate is just too much, and the needles for the MTX are so tiny compared to the Humira that he can feel the difference I guess. Poor guy.

You are right, we can always go back to weekly, and I will definitely be pushing for rechecking trough and antibodies soon!
 
Does he do his own shots? It sounds counterintuitive but it actually helped my daughters. One started doing her own shots at 13 and the other at 15 (both were on Humira and MTX). It’s also good practice for college.
Other tricks - they did their shots while watching something so they were distracted. They iced before Humira for a good 15-20 minutes (they were on the old version which really burned). You can also try Buzzy or the shot blocker (which you can get on Amazon). And of course dessert after shots helps ;)!
 
We love Buzzy! He sometimes even brings it for lab draws. I will have to start working with him on considering doing his own shots. He has been pretty hesitant about the idea in the past. Right now, his older brother distracts him with card tricks while I do the injections! Pretty entertaining.
 
I had one daughter who was very hesitant (the other just jumped right in, after me doing the first few injections - probably because her older sister was doing her own injections at the time). She actually said that I poked her too hard and therefore doing the injections herself was less painful because she knew how much pressure to use.

I was pretty surprised when her pediatric rheumatologist encouraged her to learn after S told her she hated the Humira injections (with citrate/citric acid in them, they really do burn) - but it really gave her a lot more control and confidence. Her rheumatologist also said she tried to get all her patients to do their own injections before college or before moving away from home.

Same with my younger daughter's pediatric GI - around 17 or 18, they really want them to take over their care, and that includes doing their own shots or arranging their own infusions.
 
Ditto the own shot theory. Both of my girls hated the way I did it and at 11 my youngest insisted she do her own methotrexate shots. O was I think 15, I did them for her the first few times and then she took over. O went on Humira after the formulation of the citrate free so it didn't hurt as much as the auto injector noise was surprising but she did her own from the start as she was much older at that time but said she thinks she could have done it younger also.
 
WiscoMom said:
So this was an unexpected development: my son had his bloodwork leading up to his appointment later this month, and after 6 months of adding Methotrexate injections and moving Humira to weekly to try to bring up the Humira trough level and get rid of the antibodies, his trough level went from 5 to 40! His antibodies went from intermediate to undetectable.

So now the doctor wants to stick with the Methotrexate and move the Humira back to every other week. I'm thrilled with the lab numbers, of course, but a little nervous about going back to every other week on the Humira. I've never heard of anyone decreasing the frequency...only increasing. I'm a little nervous that the antibodies (and his symptoms) will come back. Also, I've never heard of a Humira trough level that high.
Click to expand...
P
My daughter with Crohn's (now 11) started Humira at age 4 and by age 9 had Humira trough levels of 36. She was continued at weekly dosing for another year at those levels. The problem for her was she was developing significant secondary and opportunistic infections. Shingles, psoriasis, horrible sinus infections, and other unusual issues were cropping up. Eventually those problems combined with a creeping loss of response (but no antibodies) brought us to a med switch to Stelara.

Her brother with Crohn's is 13 and had been on weekly injections of Humira as well. As soon as he developed high levels (also 36!) I put in the request to move back to bi-weekly injections. His Crohn's is relatively mild and under reasonable control. Request was considered for 6 months and recently he was allowed to go back to bi-weekly. I really didn't want him to see the type of non-Crohn's issues that his sister suffered through!

So it does happen. However, now I am holding my breath a little in hopes he doesn't develop more Crohn's symptoms! I understand where you're at.
 
Pilgrim said:
P
My daughter with Crohn's (now 11) started Humira at age 4 and by age 9 had Humira trough levels of 36. She was continued at weekly dosing for another year at those levels. The problem for her was she was developing significant secondary and opportunistic infections. Shingles, psoriasis, horrible sinus infections, and other unusual issues were cropping up. Eventually those problems combined with a creeping loss of response (but no antibodies) brought us to a med switch to Stelara.

Her brother with Crohn's is 13 and had been on weekly injections of Humira as well. As soon as he developed high levels (also 36!) I put in the request to move back to bi-weekly injections. His Crohn's is relatively mild and under reasonable control. Request was considered for 6 months and recently he was allowed to go back to bi-weekly. I really didn't want him to see the type of non-Crohn's issues that his sister suffered through!

So it does happen. However, now I am holding my breath a little in hopes he doesn't develop more Crohn's symptoms! I understand where you're at.
Click to expand...

Wow! That is all very useful information, and I will definitely be asking the doctor about this sort of situation. I am a little surprised that she was so quick to move him back to bi-weekly, honestly. Such a tricky balance between managing the inflammation and preventing the secondary issues from cropping up.
 
So we are on the first attempt of trying out 2 week intervals for the Humira, and it already seems like his symptoms are getting worse. On the second day past when he would have had his weekly injection, he started to see softening of stools, and we are now seeing increased frequency as well. No other changes as far as diet, activity, stress, etc. Is it even possible that he would have an increase in symptoms after only skipping one weekly dose? Is it possible that he somehow needs the very high trough level he had to keep the inflammation down? I will definitely be asking his doctor these questions soon. He is due for his (2 week) Humira shot this Wednesday, so I think we will just wait until then, and keep tracking symptoms in the meantime.

So frustrating and disappointing.
 
My kiddo has high levels of most drugs he has been on
He also gets symptoms quickly when they try to space him out In frequency or dose
Always worth a try
Especially in the beginning
 
Definitely let the Gi know now
They may have you wait till wed
Or give the shot now to avoid a flare which is harder to control with “just humira”
 
I will definitely call first thing tomorrow (Tuesday), but knowing how communication usually works with our doctor, I won't hear back from the nurse until the next day (Wednesday) which would have been his shot day anyway! So I don't think anything will change for this week, but I'm definitely wanting to go back to weekly starting next week if she approves it.

It's scary to see symptoms come back so quickly after only being a few days out from when he would have had his weekly shot.
 
Just shows the shots are working
Any time we have had to hold shots by a few days ..
Always amazed by the symptoms and how quickly they show up
But at the same time
I breathe easier knowing the meds are working
And are needed
Hugs 🤗
 
Honestly, my kiddo is the same. Always, always needed very high doses for her arthritis (which is severe) but also high doses for her IBD (which is not severe) - she's needed a higher than normal dose of Humira, Remicade, Cimzia, Simponi...the list goes on.
We've also seen her get worse if we have to hold a dose for surgery or something, even if it's a few days. But thankfully, if we haven't had to hold it too long, she usually rebounds quite quickly.
 
Well, it seems my son may be one of those kids that also needs to maintain a very high trough level, at least for now. I called the nurse today and told her how quickly his symptoms returned (within 2 days of the first "skipped" dose), and that it was getting worse each day. She told me to go ahead and give him the Humira right away today (a day early) and she would check with the on-call doctor since my son's doctor is out of the country for the month. The on-call doctor said to go back to weekly until we can see my son's doctor when she returns from her trip.

So, overall, the decision we were hoping for, but I'm so sad that my son had to go through nearly a week of feeling rotten for a change that I wasn't too keen on in the first place. He is sad that he has to go back to two shots a week (Humira and MTX) but is hopeful that at least he may be feeling better in short order. I sincerely hope that one missed dose wasn't enough for antibodies to come back or the inflammation to return. :(
 
I wouldn't worry about the one dose being missed as far as antibodies go.

I also see this as a glass half full situation in that at least now you know that the shots are working! I hope the shot gets him straightened out in fast order!
 
I hope things improve soon. It's so hard to tell if things are getting better until you can look at a trend of a week or so. He had his Humira shot 2.5 days ago, and things seem like they might be a tiny bit better, but not the big improvement we were hoping for.
 
Normally for my kiddo
If he is delayed in his shot
We see small improvements after the shot is given
But it takes 2-3 shots given at the regular interval again before we are back to baseline
Completely
Hang in there
 
my little penguin said:
Normally for my kiddo
If he is delayed in his shot
We see small improvements after the shot is given
But it takes 2-3 shots given at the regular interval again before we are back to baseline
Completely
Hang in there
Click to expand...

Thank you. This is really helpful. It's so hard to be patient and wait for improvement.
 

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