Humira/hydrocortisone IV/Flagyl/prednisolone

[Newcrohnie]

Hi everyone.

I’m a long time reader first time poster and was hoping for some advice. I am going through a flare atm which is my worst so far. I was only diagnosed in March 2017 with crohns in the caecum, terminal ileum and rectum. I tried a few drugs but couldn’t tolerate 6mp/azathioprine and budesonide on a second try lost its effectiveness a bit. I was then put on Humira 1x 2 weeks and to transition I used a liquid diet for 3 months to bring the inflammation down, which did work a good bit. We avoided steroids as I have osteopenia. I achieved remission with Humira for 6 months or so, until last week.

This flare really scared me as it seemed so sudden and I couldn’t even tolerate the liquid diet without severe cramps. This brought me to hospital, however not my normal hospital/ consultant. In hospital I was put on hydrocortisone iv and Flagyl iv for 3 days. Had a few samples sent off and this confirmed no viral infection. Still awaiting a cal protectin result.

The hydrocortisone did seem to help as I was then able to tolerate the liquid diet again and my stool seemed better formed, in fact I then became constipated. I was discharged today with 40 mg of prednisolone to taper after 2 weeks, whilst continuing Humira 1 x 2 weeks. The consultant said if the cal protectin was 500 or more, he would recommend increasing the dosage of Humira to weekly.

I’m not entirely confident of being on Humira and 40 mg of pred at the same time. I just wish my own consultant was in the country right now. I don’t want to go against this advice though as I don’t want to flare again in the interim. Any thoughts? And apologies for the long post but I do believe sufferers know more sometimes...

 

[Scipio]

I’m not entirely confident of being on Humira and 40 mg of pred at the same time. I just wish my own consultant was in the country right now. I don’t want to go against this advice though as I don’t want to flare again in the interim. Any thoughts? And apologies for the long post but I do believe sufferers know more sometimes...

Starting the Humira while still on the prednisone makes good sense to me. Steroids such as prednisone are often quite good at quickly inducing remission, but in many cases the symptoms come roaring right back at some point during the taper. By starting the Humira while the steroid is still in there doing its best gives the Humira a better chance to "take over" the job of maintaining/improving the remission. But of course you do still need to taper the prednisone as the Humira kicks in. You cannot stay on the steroid long term.

 

[Newcrohnie]

Thank you scipio for your response. Started the pred a few days ago and still on a liquid diet. Will be seeing the dietician tomorrow and hopefully the consultant next week to discuss things further, even though I’m having to pay privately but needs must. Hoping the prednisone acts quickly so I can have some solids again.

Thanks again.