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Humira vs Stelara

Just wondering if anyone had any information or studies about which one may the better option? My husband has had crohns for 6 years, entocort for 2 and has been on mercaptopurine for almost 5 years (5 in April) Found out Monday he still has some ulcers and a couple strictures (even though he has zero symptoms ZERO and absolutely perfect bloodwork 🙄🤷‍♀️) so Humira was recommended but I'm almost more interested in Stelara since it seems to be more of a gut med than a systematic thing. But I also know Humira has been around a lot longer. I left a message with his doctors nurse to ask her as we are still waiting on insurance and blood work before he can make the switch. Any input and advice is welcome! Thanks everyone
 

my little penguin

Moderator
Staff member
So the thing is insurance wise
Most require you try the “cheaper “ biologics first
Then fail those
Then go to the pricey ones
Humira tends to be $$$$(4 figures) for a box of two shots
Vs Stelara is $$$$$(5 figures ) for one shot

my kiddo has been on
6-mp
Then mtx
Then remicade (8 months ) - allergic reaction
Followed by humira 5 plus years
And now Stelara going on 4 years
All are very safe drugs imo
No issues and my child started biologics at 8
He is now almost 18

humira is very safe -used for years in juvenile arthritis as young as 2 maybe 3 -4
Also years in crohns
Works well
Works quickly 3-4 months to be effective in most
Very good for the whole gut (small intestine/large intestine/rectum)
my kiddo had clean scopes on humira -so clean they questioned crohns dx

remicade is also extremely effective-good at fistulas
Abscess etc…
Very safe as well
takes 6-8 weeks to be effective
Very good for the whole gut (small intestine/large intestine/rectum)

Stelara takes 6-8 months to be effective
Fda approved dose is every 8 weeks at 90 mg
However my kiddo needed every 4 weeks at 90 mg
Works well on the small intestine-TI area but not as good on the large intestine (colon)
Scopes on Stelara at every 8 weeks still had inflammation present in TI ..

entyvio takes on Average 12 months to work .
Works great on large intestine (colon )
Not so good on small intestine (TI )
Some develop joint issues while on it .

that’s it for drugs
which is why you try the

biologics first (anti tnf ) then move to Stelara

depending on other factors you might get Stelara approved first

tagging @Scipio
 
So the thing is insurance wise
Most require you try the “cheaper “ biologics first
Then fail those
Then go to the pricey ones
Humira tends to be $$$$(4 figures) for a box of two shots
Vs Stelara is $$$$$(5 figures ) for one shot

my kiddo has been on
6-mp
Then mtx
Then remicade (8 months ) - allergic reaction
Followed by humira 5 plus years
And now Stelara going on 4 years
All are very safe drugs imo
No issues and my child started biologics at 8
He is now almost 18

humira is very safe -used for years in juvenile arthritis as young as 2 maybe 3 -4
Also years in crohns
Works well
Works quickly 3-4 months to be effective in most
Very good for the whole gut (small intestine/large intestine/rectum)
my kiddo had clean scopes on humira -so clean they questioned crohns dx

remicade is also extremely effective-good at fistulas
Abscess etc…
Very safe as well
takes 6-8 weeks to be effective
Very good for the whole gut (small intestine/large intestine/rectum)

Stelara takes 6-8 months to be effective
Fda approved dose is every 8 weeks at 90 mg
However my kiddo needed every 4 weeks at 90 mg
Works well on the small intestine-TI area but not as good on the large intestine (colon)
Scopes on Stelara at every 8 weeks still had inflammation present in TI ..

entyvio takes on Average 12 months to work .
Works great on large intestine (colon )
Not so good on small intestine (TI )
Some develop joint issues while on it .

that’s it for drugs
which is why you try the

biologics first (anti tnf ) then move to Stelara

depending on other factors you might get Stelara approved first

tagging @Scipio
Wow, Thank you so much!! You have tons of knowledge! I am so sorry about your son but how lucky he is to have an advocate like you! So basically we will more than likely need to do the Humira first then? I cannot remember if my original post had all of the following so forgive me if I'm repeating 🤦‍♀️ My husband has been on mercaptopurine for almost 5 years (I don't love that drug and the possible side effects but doc has assured us its extreme rare to have cancer on any of them) and felt great, labs great, energy great all was great until he got scoped on Monday and while 50% of his ulcers were gone and normal mucosa was present he had 3 strictures (2 were ballooned and 1 wasn't because it had an ulcer on it so they didn't mess with it) so we are a little bummed that whole he seemed so well... he isn't totally. And the strictures freak me out *doc isn't worried as he said they aren't fibrotic or bleeding at all and was able to get a pediatric scope through* but I am terrified. Any input?? My husband also does loads of natural things as well.
 
Location
San Diego
All the studies and reports I've seen indicate that Stelara is both safer and more effective.
Safer definitely, but's it's debatable whether Stelara is more effective than Remicade. Some studies that I have read say they are about equal and some say that Remicade is modestly better. I do know that Remicade is still widely regarded among GIs as the most effective biologic.

Stelara's big advantage is in safety. It seldom produces any side effects and it's even rarer for it to generate anti-drug antibodies - often making addtion of MTX or azathioprine unnnecessary.

I'm on Stelara myself and I've been very pleased with it. IMO its main drawback is its extremely high price. If you have good insurance that qualifies for the Janssen CarePath program you can get it for only $5 per dose, which is wonderful. But if you are on Medicare or other US government insurance you won't qualify for CarePath. So unless your income is then low enough to qualify for the assistance program directly from Janssen, you can expect to spend many thousands of dollars for your Stelara.
 
Location
San Diego
so Humira was recommended but I'm almost more interested in Stelara since it seems to be more of a gut med than a systematic thing. But I also know Humira has been around a lot longer.
Stelara is also systemic in its action, which is why it is also used to treat psoriasis and rheumatoid arthritis, among other things. The biologic that is gut-specific is Entyvio - the other new, non-TNF biologic.
 
Safer definitely, but's it's debatable whether Stelara is more effective than Remicade. Some studies that I have read say they are about equal and some say that Remicade is modestly better. I do know that Remicade is still widely regarded among GIs as the most effective biologic.

Stelara's big advantage is in safety. It seldom produces any side effects and it's even rarer for it to generate anti-drug antibodies - often making addtion of MTX or azathioprine unnnecessary.

I'm on Stelara myself and I've been very pleased with it. IMO its main drawback is its extremely high price. If you have good insurance that qualifies for the Janssen CarePath program you can get it for only $5 per dose, which is wonderful. But if you are on Medicare or other US government insurance you won't qualify for CarePath. So unless your income is then low enough to qualify for the assistance program directly from Janssen, you can expect to spend many thousands of dollars for your Stelara.
Thanks for the feedback! His GI is not considering Remicade right now only Humira and I asked about Stelara but still haven't heard back 😕 I've heard its best to start with a quicker acting biologic than Stelara especially since there's stricters and some ulcers. Do you have any opinions on that? We do have good insurance thankfully. Were you on anything before Stelara?
 
Location
San Diego
Thanks for the feedback! His GI is not considering Remicade right now only Humira and I asked about Stelara but still haven't heard back 😕 I've heard its best to start with a quicker acting biologic than Stelara especially since there's stricters and some ulcers. Do you have any opinions on that? We do have good insurance thankfully. Were you on anything before Stelara?
Humira and Remicade are of similar effectiveness, since they both bind with TNF. Stelara is the only biologic I have taken. Before that I was on occasional short courses of Entocort.

I know that the word on Stelara is that it takes a long time to kick in, but that was not my experience. My symptoms started getting noticeably better about 2 weeks after the intial loading dose. And a few others on this board have reported similar experiences. But I think we are in the minority on that.
 
Humira and Remicade are of similar effectiveness, since they both bind with TNF. Stelara is the only biologic I have taken. Before that I was on occasional short courses of Entocort.

I know that the word on Stelara is that it takes a long time to kick in, but that was not my experience. My symptoms started getting noticeably better about 2 weeks after the intial loading dose. And a few others on this board have reported similar experiences. But I think we are in the minority on that.
Oh ok, thanks!! My husband did entocort his first year and a half before mercaptopurine.
 
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