New Treatments

[newdiagnosis]

Are there any new biologics coming out in the pipeline for Crohn's? Kinda worried that this stelara might not end up working.

 

[ronroush7]

What other biologics have you tried?

 

[newdiagnosis]

Stelara is the only one I tried. Been on it for 4 weeks.

 

[ronroush7]

There is also Remicade, Humira, Entyvio , Cimzia and I think one other that I cant think of right now. I hope the Stelara works for you.

 

[ronroush7]

Simponi was the other one i was trying to think of.

 

[Guerrero]

Anyone know if there is some other treatments closed to be aproved for Crohn's or like in phase 3 study?

 

[aypues]

Stelara is the only one I tried. Been on it for 4 weeks.

Stelara isn't a 1st line therapy for Crohn's. Kinda weird they would put you on that right away. Remicade is the most effective of the biologics, but even that doesn't work for everybody.

Mongersen is in the pipeline and is promising. They may put me in a trial for it if Stelara doesn't work.

 

[my little penguin]

Second that ^^^^^
First line is remicade
Then humira
Then cimzia or Simponi or entivyio as third line
Last ditch effort is Stelara for Crohns

After that there is ivig and stem cell or fecal transplant

 

[my little penguin]

One last thing Stelara is very slow acting
Takes a minimum of three weeks but up to 6 full months before it's effective for Crohns

 

[my little penguin]

http://online.ccfa.org/site/DocServer/CCFA_Ingle_5_2016_--_What_s_New_IBD.pdf

 

[aypues]

Second that ^^^^^
First line is remicade
Then humira
Then cimzia or Simponi or entivyio as third line
Last ditch effort is Stelara for Crohns

After that there is ivig and stem cell or fecal transplant

In my last appt my doc said Entyvio isn't as good for Crohn's (better for UC), and even less so for people that fail Remicade based on the data. She isn't a big advocate of trying every TNF therapy as they all have the same mechanism of action.

 

[Scipio]

Etrolizumab - another new anti-integrin biologic has been in clinical trials for a while. It should be out in another year or two. One advantage it has is that the clinical trials are comparing head-to-head against Remicade and Humira.

http://www.etrostudiesresearch.com/etro-studies/

 

[newdiagnosis]

http://online.ccfa.org/site/DocServer/CCFA_Ingle_5_2016_--_What_s_New_IBD.pdf

I was given the option for stelara because of it's safety profile. The only reason it is not considered first is because it is only newly approved for Crohn's. Most docs are not comfortable prescribing this med because it is so new. There is no reason why stelara can't be used firstline.

 

[my little penguin]

Question
You keep referring to a better safety profile ?
What particular risk association does other biologics (remicade humira etc..) specifically have that Stelara does not ?

Do you have a link to a study or paper etc...
I would really like to read it since Ds is on Stelara now

Ds has been on both to my knowledge the only lower risk is for TB since anti tnf stops the body from fight against TB
And
Il12/il23 are not involved in that process-so theoretically lower TB risk
But risk of fatal cancer /infection and fatal brain issues still are associated with Stelara

 

[my little penguin]

The number one reason why Stelara isn't used first in the US at least
Insurance
Most require patients to start with the cheapest meds 5-ASA
Move up to immunosuppressants (6-mp/mtx)
And then biologics
Some require proof of failure by humira before remicade even
Then they may approve Stelera

 

[eleanor_rigby]

Anti - TNFs are associated with multiple sclerosis risks that the others are not

 

[Scipio]

Question
You keep referring to a better safety profile ?
What particular risk association does other biologics (remicade humira etc..) specifically have that Stelara does not ?

Do you have a link to a study or paper etc...
I would really like to read it since Ds is on Stelara now

Ds has been on both to my knowledge the only lower risk is for TB since anti tnf stops the body from fight against TB
And
Il12/il23 are not involved in that process-so theoretically lower TB risk
But risk of fatal cancer /infection and fatal brain issues still are associated with Stelara

Based on it's years of use in treating psoriasis, Stelara (ustekinumab) has a lower risk of serious infection than Humira and especially lower than Remicade:


http://www.medscape.com/viewarticle/844901

Table. Cumulative Incidence Rate of Serious Infection by Treatment Group

Treatment Serious Infection per 100 Patient-Years
Ustekinumab 0.83
Etanercept 1.47
Adalimumab 1.97
Infliximab 2.49
Nonmethotrexate/nonbiologics 1.05
Methotrexate/biologics 1.28

 

[Maya142]

People who do not respond to anti-TNFs are called primary non-responders. For them, it doesn't really make sense to try every other anti-TNF.

But there is a group who do respond to anti-TNFs and over time lose that response. The theory is that your body builds antibodies to the drug over time. This especially happens with Remicade, though it could happen with the other anti-TNFs too, definitely.

That subgroup of people DO often respond to a second or even third anti-TNF.

My older daughter is one of those people.

Entyvio did do better in UC, but everyone is different, so there's no real way to know that it won't work for you if you have Crohn's. Our GI also says she has found it works better on mild-moderate Crohn's, less well for severe Crohn's.

We were told Stelara would take 6 months or so to work - it is "slower acting" than Remicade/other anti-TNFs, according to our GI.

 

[Tuff]

One rare side effect of anti-TNF is peripheral neuropathy. Since I got it from Remicade, I don't think I can try the rest of them. So I'm on Stelara. If it doesn't work, I hope there are other things coming down the pipe. I'd like to keep my large intestine for a while longer.

 

[ronroush7]

One rare side effect of anti-TNF is peripheral neuropathy. Since I got it from Remicade, I don't think I can try the rest of them. So I'm on Stelara. If it doesn't work, I hope there are other things coming down the pipe. I'd like to keep my large intestine for a while longer.

I think that might have happened to me.

 

[newdiagnosis]

I will look up the studies but anti tnfs are a more broad spectrum drug. They are sorta like pred nisone in respect to where they act in the immune system. Stelara is more specific biologic. Stelara has been out for less time than tnfs, but so far the studies do not show as many risks as anti tnfs. The theoretical risks are still the same but studies show that stelara is pretty safe. Sorry I don't have the time to post links etc. But I did my research.