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Nearly Two-Thirds of Patients Respond to Mirikizumab Treatment at 12 Weeks...

Location
San Diego
Good news but not surprising. Mirikizumab is one of several new drugs in clinical trials that suppress the immune system by binding and blocking the cytokine IL23 - meaning that its action should be similar to Stelara, which also binds IL23.
 
Does that mean Mirikizumab/Stelara just disables a different part of the immune system than Humira? Our doctor calls Stelara a different class of drug than Humira (same class in terms of immune suppressant?) and I don't understand why.

Also, based on what I've heard so far, Stelara has a better safety profile compared with Humira. How does Stelara achieve that?
 

my little penguin

Moderator
Staff member
Please see ccfa

Immunosuppressants are methotrexate and 6-mp/imuran

biologics suppress the immune system as well
Anti tnf alpha drugs are remicade , humira , cimiza and simponi
IL-12/IL-23 Stelara
Entyvio does a different pathway


all affect/suppress the immune system
All have been around for years
Remicade and humira for decades - both have excellent safety profiles

Everyone reacts differently to biologics and the type of biologic that works for your child may Not Work for someone else
Also just because remicade or humira worked well doesn’t meant Stelara will work as well
Or entyvio

conversely if remicade didn’t work
Stelara may or may not work
 

my little penguin

Moderator
Staff member
Also safety profile is very different than infection risk
Humira and remicade have a slightly higher risk of secondary infection than Stelara
Just slightly
My kiddo was on remicade age 8
Then humira 9 to 13
So exposed to lots of elementary school abd middle school crude /colds
He was rarely sick ever

my non ibd child caught every bug under the planet.

humira /remicade doesn’t make you more likely to catch a cold
They make a opportunistic infection like pneumonia more likely to happen after the flu
Or other major illness
 
Location
San Diego
Does that mean Mirikizumab/Stelara just disables a different part of the immune system than Humira? Our doctor calls Stelara a different class of drug than Humira (same class in terms of immune suppressant?) and I don't understand why.

Also, based on what I've heard so far, Stelara has a better safety profile compared with Humira. How does Stelara achieve that?
The immune system is a highly complex web of interacting cells and chemicals (usually proteins). The immune system can be suppressed or partially suppressed at many different points by blocking the interaction between the cells and/or chemicals at that given point. Remicade, Humira, Simponi, and Cimzia all act by blocking the the action of the protein TNF. Stelara, mirikizumab, and several other new drugs all act by blocking the action of a different protein: IL23. Stelara also blocks the action of IL12, but that is thought to be mostly beside the point with respect to Crohn's.

Stelara and Humira both partially suppress the immune system, but they are considered to be different a "class" of drugs from each other because they work at different points in the huge immune system web. The trick in finding a good treatment for Crohn's is to find the best point at which to block some part of that immune web to dampen the Crohn's inflammation way down but without knocking the rest of the immune system so far down that it leaves the patient highly vulnerable to infection and/or cancer. Entyvio is in yet another class of drugs. It works by blocking the binding, and hence the interaction, between two different cells of the immune response.

Stelara patients do show slightly lower risk of infection or cancer compared to Humira or Remicade, hence the "better safety profile." But at the same time it is slightly less effective in controlling the Crohn's in some patients.

All the drugs that work by weakening the immune system walk the same knife edge of risk of infection/cancer on one side and risk of worsening Crohn's inflammation on the other. They try to find and stay in the sweet spot in the middle, but they sometimes fall off on one side and sometimes on the other.
 
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