Remicade

[crohns_disease]

Hi
Was wondering how remicade can help achieve remission as humira is not working and the doctor is thinking of a change
Firstly, does remicade help reach remission by itself or will it be needed with other drugs e.g azathioprine?
Secondly, will remicade help affect growth in anyway?

Thanks in advance for any answers

 

[Patricia56]

Two things affect growth - remission and nutritional status. Without remission there is usually very little growth, although this is not always the case. Improving his nutritional status may help his growth even if he isn't in remission but it be much more helpful if he is also in remission

Remicade suppresses part of the immune system which will hopefully then reduce the inflammation in his gut. Basically, the inflammation is a result of the presence of too many white blood cells. So suppressing their numbers should suppress the inflammation. Humira does this too but he's not responding to that apparently so they will try a different drug in the same class. Some people respond to one and not the other.

It will be the doctor's call whether to combine it with AZA or MTX or use it alone. Different docs have different opinions on this. For adolescent boys there is a small concern that using AZA alone or in combo with other meds may very slightly increase their risk for cancer so our son's doc is not using AZA in combo with Remicade. My son was already on MTX and they have continued that along with Remicade to help prevent the formation of antibodies to the Remicade.

 

[crohns_disease]

Thank you
Is there a time scale in which people generally start to respond to remicade? Looking forward to starting it so I can hopefully get into remission and start growing

 

[Patricia56]

As far as I know it is considered a failure if there is no response within 12 weeks. Now some response doesn't mean complete remission. That may take longer. But some people have a remarkable response. My son saw a very noticeable improvement (went from inpatient to outpatient) in 3 days after his first dose. Then things slowed down and after the loading doses we had to go to every 4 weeks dosing. We are now trying to move that out to 5 weeks to see if he can go that long. I'm not sure yet if I consider him to be in remission but his labs are fine and he has no apparent symptoms. That doesn't mean he has gotten healing at the endoscopic level which is true solid remission.

If you are on prednisone or entocort you will not grow until you are completely off those meds.

Have you had a bone age and bone density (DXA) scan done? Those are both very helpful - the DXA scan is very important regardless of the bone age test.

 

[crohns_disease]

Not had either done but have heard a lot about them

What information is expected to be gained from doing these tests? Does it help tell how much time of growing you have left and when the growth spurt will occur?

 

[Patricia56]

A bone age tells how delayed (if any) your bone growth might be. So if you are 2 years behind your actual age you supposedly have 2 extra years beyond the normal range to grow.

You should absolutely have a DXA scan done. It should have been done as part of your workup after you got a diagnosis. It tells you the strength of your bones. Most people with CD don't have strong bones. Some have osteoporosis where they are at risk of breaking bones when most people wouldn't. That requires special treatment. The only way to tell if you have poor bone strength is with a DXA scan.