Inflammation on Remicade

[xmdmom]

Adult LO with Crohn's for about 12 years, Remicade (regular dosing q 6 weeks) for 10 years, ileal disease with some narrowing. Calprotectin 50's and 60's on two checks (normal less than 50). MRI ( no gadolinium) abnormal signal, mucosal thickening terminal ileum. Some loose stools, occasional stomachache and lower appetite. CRP was normal. This looks like Remicade isn't taking care of all the inflammation. What further tests are needed? What are the treatment options?

 

[Scipio]

What is the trough concentration of Remicade in the blood, and are there anti-drug antibodies present?

 

[xmdmom]

I would have to look for the trough but I know it was high, so it doesn't seem to be an issue of not enough Remicade.

 

[xmdmom]

Remicade level trough was 26 ug/ml. No antibodies checked as far as I know.

 

[Scipio]

26 is pretty high, so you are right that low levels of drug is probably not the problem. You could perhaps suggest adding an immunosuppressant such as azathioprine or methotrexate to give the Remicade a helping boost. Or you could consider switching to another biologic such as Humira or even a new class of biologics such as Skyrizi or Stelara.

In general, I'd ask the doc what he/she thinks and probably follow that.