Remicade Use for Crohn's and Inflammatory Response

[zritz]

I have had Crohn's disease for a little over 2 years. I have been using remicade to treat it, every 7 weeks. Like clockwork a day or 2 before I get an infusion, my body begins to shut down. I get severe chills, my joints swell and ache and I get severe rectal pain. Tylenol helps stop the chills and aching, but only the remicade seems to stop it completely. Has anyone else experienced this and understand what is happening? Looking for any insight.

 

[crohnsinct]

Remicade is metabolized by the body so you will be at your lowest drug level at infusion. It could be you are running out of meds by the time the 7 weeks is up. There is a simple blood test to test your levels and if you are in the USA Janssen pays for it. I would let your GI know and perhaps they will test your levels and adjust your dosing or interval accordingly.

 

[zritz]

Thank you for the response. Would it be fair to say that as the remicade wears off (if metabolized) I experience this inflammatory response as a result? If so, is it caused by the Crohn's itself or is it more of my body's response to a lack of remicade? I had a particularly powerful round of the above mentioned symptoms plus abdominal pain last night, 2.5 weeks from my next infusion, much earlier than I have in the past.

 

[crohnsinct]

Both. It is the Crohn's because there is no drug in the body.

If it happens closer end of infusion cycle our GI will usually assume the drug is wearing off. However, only 2.5 weeks is fast. Could be something else but our first step would be fecal calprotectin to see if there is gut inflammation and symptoms are a result of that. If so, then a levels test. If levels are low and antibodies are low, then a dose escalation and tightening up the schedule might work.

Antibodies will also cause an increase in drug clearance and those are tested for with the levels. Depends on the level of antibodies. Up to a certain point they might add an immunomodulator to help slow drug clearance. If they are too high then a switch in drug.

Also, disease activity will increase drug clearance (drug lost due to permeability of mucosa) so it is not unusual to find after flares or at dx you might need a higher dose and shorter schedule but as you heal and remain in remission dose can be brought down and schedule could be moved out.

 

[shamrock15]

Checking your levels is a simple blood test they do immediately before your infusion. If you are getting this every time, ask your GI to submit a requisition for the blood test. If you are indeed low it can be a simple adjustment to either your dose or increase the frequency to 6 weeks instead.

 

[crohnsinct]

I wanted to clarify also that Janssen pays for two tests per year. More than that and you would have to check with your insurance but as of a year or so ago most insurance companies were not covering it. That could have changed by now though.