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Hi. I am recently diagnosed with ileitis, most likely crohn's. I also have knee swelling. I was initially put on Lialda, but it seemed like Lialda gave me more diarrhea. I asked my doctor to prescribe me Pentasa, which is more directed at the terminal ileum. Will the Pentasa likely work, or will I likely experience the intolerance that I had with Lialda. My doctor also put me on entocort. Unfortunately, my insurance doesn't cover Pentasa right now, so I am also in the process of appealing and changing insurance so that I can get Pentasa. Any advice would be appreciated.
My doctor does't really have strong opinions. Was wondering what you all thought.
I was prescribed lialda after my scope showed a small, mild patch of inflammation in the transverse colon and a small patch in the terminal ileum. It's been working well for me. My doctor said when he prescribed it that the lialda should start releasing in the last part of the small intestine and the continue throughout the large intestine. So it should hit the inflammation in your terminal ileum
I also have united healthcare. They covered Pentasa for me but it's like $50 for 180 pills. I am in California, not sure it is different for certain areas. I tried taking it but it didn't help with the pain I was having on the right side. But it cleared the ulcer I had on my ileum that the pill cam confirmed. I still don't have a diagnose right now and still experiencing the pain for the past several months.
All the 5-Asa drugs (Canasa, Apriso, Lialda, Pentasa, Asacol, and Rowasa) treat only the surface of the intestine, and are not approved as monotherapy for crohn's since the inflammation extends through all layers of the intestine. They are used alone for ulcerative colitis since the inflammation is present only on the surface. Budesonide is a more effective treatment, especially since your disease is located in the ileum. The other medications your GI could prescribe are immunomodulators like mercaptopurine, azathioprine, and methotrexate which have excellent safety profiles in crohn's. Would your insurance approve Pentasa with a prior authorization? You've tried Lialda and it didn't work, so the next step is usually another drug of the same type. My old insurance used to do this with PPIs, but I had already been through most of them so it was fairly easy to get the next type approved.

The following provides an overview of the different drugs and their effectiveness (for ulcerative colitis):


I hope you feel better.
Thank you for your reply. Right now I am on entocort and Lialda. Maybe the Lialda initially led to worsening of symptoms because it was monotherapy. Right now my symptoms are well controlled on entocort and Lialda. Do people usually go on double therapy (5ASA and entocort), and gradually taper the steroid to see if the 5ASA works? Pentasa is not on the formulary, so Lialda is the only option. I did send a formal appeal to see if they would switch.
Thank you Jabee. I am somewhat hesitant about starting immunomodulators at this point. Do you think that after controlling the inflammation with entocort, I am maintain remission with a mesalamine?