Remicade trough level

[xmdmom]

My adult son w crohns complained of diarrhea and loose stools towards the end of the 8 week inflectra cycle. His Dr. checked a trough level and switched him to every 6 weeks. Today I asked my son to look up the trough and it was 17 ( normal 5 or greater)

Does the changing of inflectra to q 6 weeks make sense given that the trough remicade level is not low?

On every w 6 weeks inflectra, will his level end up being too high leading to more immunocompromise?

He’s getting 5.9 mg/kg inflectra dose.

 

[Scipio]

I'm confused: was the 17 reading a 6-week trough or an 8-week trough? Also, were anti-drug antibodies checked, and if so what was the result?

The doc may be trying to overpower anti-drug antibodies and restore remission by giving big doses.

I doubt that the dose will be "too high." Toxicity or other bad effects from high levels of Remicade are rare and mild. Assuming the biosimilar Inflectra behaves the same way, boosting the dose should not be a big safety problem.

 

[xmdmom]

8 week.

Mayo checks antibodies if trough less than 5, so they didn’t check.
He’s been on Remicade or Inflectra for 8 years or so.

He was hospitalized with a bad cellulitis twice 2 summers ago so that’s why I’m worried.

 

[Scipio]

Boosting drug after a trough of 17 does seem like perhaps the drug has stopped working, and the doc may be beating a dead horse. But, as I said, the doc may be taking a shot at overcoming antibodies and restoring response.

I'd say give the 6-week thing a try, but if it doesn't work, ask the doc to evaluate him for switching to another drug - Humira or Stelara or something.

 

[xmdmom]

I believe his CRP was normal/ low so we’re not sure it’s crohns( just seemed to have the GI issues in last 2 weeks of inflectra cycle.

He has another more serious illness that may be affected by GI inflammation so I guess that’s why the doctor is being aggressive.

 

[Scipio]

I believe his CRP was normal/ low so we’re not sure it’s crohns( just seemed to have the GI issues in last 2 weeks of inflectra cycle.

Normal CRP may or may not mean anything, since CRP is a relatively insensitive test for inflammation. If the CRP is high then there is almost certainly inflammation. But if it is low it may mean the inflammation is gone or it may mean that the inflammation is there but the CRP test missed it.

 

[Maya142]

I agree with Scipio - I doubt it will hurt him and it's worth a try. He may be losing response to Inflectra, but on the other hand, it's possible that every 6 weeks will work, at least for a while.
My daughter is re-trying Remicade and it only lasts for 3 out of 4 weeks, even at 10 mg/kg. She does have symptoms in that last week, but right now it's working well enough that we're sticking with it (also because she has no new med options for her inflammatory arthritis and Remicade works well for her Crohn's).