Should I start Remicade/Humira?

[ccerulean]

Hi, I was dxed with Crohn's this past February after a flare in January, (no prior GI problems). I take Pentasa and just finished tapering off of Entocort as of last Thursday. I've been on a low residue diet for 5 months so far. This June has been the best I've felt since the beginning of the year. My main symptom of pain has been minor to nil. I have more good days than bad. I finally thought as if I am recovering.

Until I saw my GI doctor today.

He is concerned that Pentasa will not reduce any lingering inflammation (TI), which could cause the inflammation to increase or cause scar tissue. He has offered me the option to start on Remicade or Humira. I have concerns mainly because this is all so new to me, I don't know what my pattern of chronic illness will be like. I told him I would like to stick with the Pentasa for that reason and he understood but said the option to use the "tried and true" medications like Remicade/Humira was there for me.

Did I make the right decision? Now I'm second-guessing myself. My Crohn's symptoms are mild but my inflammation back in January was severe. I'm so confused. Any advice would be appreciated!

 

[DJW]

Hi. I've lived through the damage under or undertreated crohns/inflammation can do. When I was diagnosed I didn't respond to any of the meds or diet interventions at the time. I never want to go through that again.
If I had the chance back then biologics would be a no brainer decision.

 

[Orchid]

The long term damage inflammation can cause is vastly worse than the minor side effects of whatever biologic you'd be on. Not being in remission means your intestines are slowly rotting/scarring and the longer you wait to get there, the more likely surgery becomes and surgery in CD is rarely the end. It just starts a cycle where you get intestinal scars from the surgery and then they have to go and cut out THOSE ONES and you can see where this ends, all while the CD is blooming right from where they cut the intestines out of you.

You want to be on a biologic, trust me. You'll get an injection site reaction, a little redness and itchiness, maybe a fever and a headache and you'll need to get a flu shot every year just to be safe, but nothing else in all likelihood.

 

[ccerulean]

My concern is less about side effects and more about continued response. I have read that one can build up antibodies to these meds-- what if they fix me now, but if I eventually get worse in the future, do I then have no course of action?

Also, how long does one stay on Remicade/Humira? Until clinical remission, or forever?

 

[Orchid]

The rest of your life, if you stop the disease is likely to come back. If you develop a resistance to one drug, there are more. Remicade, Humira, Cimzia, and Entyvio are most IBD focused but there are other ones.

 

[ccerulean]

If Remicade/Humira are so effective and relatively safe, why do doctors prescribe steroids at all?

 

[DJW]

Steroids are fast acting to bring down inflammation. They are not for long term use.

 

[Orchid]

Correct, prednisone and budesonide are more effective at instantly killing inflammation but weakening the immune system also means they slow the healing process.