Questions about Humira/biologic meds?

[Moriati]

So, I have been on Humira for approximately 1 and a half years now. I have achieved perfect remission in terms of Crohn's - no stomach pain, no diarrhea, and I can eat anything!!! It's great! But...

I have a question about biologic medications/TNF blockers that the internet has not been able to answer. I have been told by several gastro dr's that biologics can, and often do, stop working at any time for no reason at all, whether you have been on the drug for 2 years or 20 years.

Have you guys on biologics achieved some degree of remission, only to have your biologic medication just stop working for no discernible reason? I haven't managed to find any statistics about the proportion of patients this happens to.

Thanks in advance - I am very curious.

 

[ronroush7]

Hi. I am on my fourth biologic. The first one was Cimzia. It worked fine for maybe a year or more. Then it stopped. Yes, I have heard the same that you have heard about biologics.

 

[Allears4u]

I have been on Humira for 9 years. It did great for the first 5-6 years. Since then I have had 3 flares. The first two times the doctor prescribed a reboot. I.e. A starter dose of 4 shots followed two weeks later by two shots, and then back to one every other week. Both of these worked to put me back into remission. I am currently in another flare. Saw Doctor yesterday for a flex sig. Things don't look good. We are going to try another reboot, but if that doesn't work we are talking surgery.

 

[ronroush7]

I have been on Humira for 9 years. It did great for the first 5-6 years. Since then I have had 3 flares. The first two times the doctor prescribed a reboot. I.e. A starter dose of 4 shots followed two weeks later by two shots, and then back to one every other week. Both of these worked to put me back into remission. I am currently in another flare. Saw Doctor yesterday for a flex sig. Things don't look good. We are going to try another reboot, but if that doesn't work we are talking surgery.

Hope the reboot works.

 

[Scipio]

It is fairly common for the biologics to falter or fail after a while. The medical term is Loss of Response, often abbreviated as LOR. This is usually due to the body eventually coming around to seeing the drug as a foreign protein and thus making antibodies against it that block its action. It can also be due to the drug having unfavorable pharmico-kinetics (PK), meaning that it is cleared quickly from the blood and thus has too short of a "hang time" in the blood to exert its full biologic effect.

LOR can sometimes be overcome by simply boosting the dose, and in some cases by also paring with Imuran or other immunosuppressant to tamp down the immune response. If that doesn't work the next thing to try is switching to a different biologic. You end up sort of moving multiple pieces around the therapy chessboard to stay one step ahead and keep the disease boxed-in.

 

[DougUte]

Yes, unfortunately failure of the med does happen, but there is a reason. The body starts producing anti-bodies to fight the drug. Usually they will increase the drug amount. With Humira they usually go to weekly injections.