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If Humira fails, which biologic to try next?

Hi there!

I'm currently on Humira and still at the start of it (five weeks in - have had loading doses 160mg, 80mg, and had one 40mg dose so far). There has been absolutely no change and even some worsening of symptoms. I know I have a while longer to wait to see if it is effective, but I'd like to weigh up my options in case I need to change treatment after 12 weeks.

My IBD nurse says they would probably try Remicade or Entyvio next if necessary, and I wondered which would be the logical one to try. To me it would make sense to choose the one which is more different from Humira, but I don't know if that is the right approach.

Any advice would be great.
 
I don't really know. Entyvio, according to the commercial, is exclusively for Crohn's. I hope the Humira works for you.
 
Entyvio is the "more different" one. Remicade is like Humira in that it is also a TNF blocker but it is a combo of human and mouse protein vs Humira is fully human protein.

Entyvio is totally different and works on different proteins.

That said I wouldn't be thinking of switching yet. 5 weeks is early yet. Some docs would even go beyond 12 weeks if you start showing any level of improvement. Some people just take a long time to respond (it took 4 Remicade doses for me, 3 months to start showing even a bit of improvement. And I'm so glad I didn't stop after the first 3 doses because even though it was frustrating at the time it was worth it).
 
Thanks FrozenGirl,

Don't worry, I have no plans to stop any drugs without giving them the full time to work. I also have other factors that are not helping at the moment - stress and a viral bug that just won't shift - and I'm hoping that they will pass and things will improve there.

I just like to be well informed in case I do need to make any changes in the future. Hopefully it won't be necessary - fingers crossed.
 
Ah. Hopefully it's just the bug messing with your system and Humira will work for you. I know colds make my symptoms worse (how unfair right?)
 
Are you on Humira alone? My GI always has me start it with a combo. So he usually has me on Prednisone or Imuran and now Entocort to help with the inflammation. Once I have been on the Humira for awhile then I taper down until I am no longer on it. Usually the Humira helps me very quickly. I just did my loading doses again yesterday! Had to be off due to an infection. Hope Humira works for you. It has helped me alot!!
 
Are you on Humira alone? My GI always has me start it with a combo. So he usually has me on Prednisone or Imuran and now Entocort to help with the inflammation. Once I have been on the Humira for awhile then I taper down until I am no longer on it. Usually the Humira helps me very quickly. I just did my loading doses again yesterday! Had to be off due to an infection. Hope Humira works for you. It has helped me alot!!
 
Hi valb,

I have asked the nurse to find out whether my consultant will add in a short course of pred to get things going. That worked well for me when I started on azathioprine years ago, but I have problems with CMV recently so I'm not sure if that will affect my options.
 
I have been on both remicade and humira and out of the 2 remicade was way more effective for me but i wasnt dosed high enough and built up antibodies to it so they switched me to humira, that stopped working and injust had a terminal ileum resection (almost 3 feet worth) and they are going to try me back on the remicade to keep it under control
 
Hi valb,

I have asked the nurse to find out whether my consultant will add in a short course of pred to get things going. That worked well for me when I started on azathioprine years ago, but I have problems with CMV recently so I'm not sure if that will affect my options.
In my experience and also friends of mine have had better luck with combinations. Sorry about CMV!! Hopefully they could figure something out for you. I was also switched from Biweekly injections to weekly which worked better for me.
I did ask to be switched to Remicade since if's an infusion every 6-8 weeks but I had an allergic reaction so no Remicade for me!! I would definitely give the Humira some time to work. It has always made me feel better quickly but everyone/ every disease is different. Keep us posted!
 
I was on Humira for a few years, but was taken off when I developed Crohn's related arthritis non RA and put on Entyvio. I do remember Humira taking a little while to really work though, so I would give it more time to work.
 
Thanks everyone. I'll be 6 weeks in on Wednesday, so I'm prepared to give it another six weeks.
Unfortunately, at the moment I'm on a backwards slide - average BMs gone from 5-6 per day to 8-9, so I'll have to see how it goes if it carries on deteriorating. I see my nurse anyway next week.
 
Quick update:

Things have been getting worse over the last week to the point where I just sat and cried to my IBD nurse this morning.

So I've been given a 30mg tapering dose of Pred, which is what I was hoping for (as much as you can hope for any of these crappy drugs!) while my antibodies are being checked. Depending on those results then the plan may be to increase the Humira dose, or to switch to another biologic.

Fingers crossed.
 
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