My kiddos have been on both. I think for IBD, insurance does tend to agree to Remicade - even before Humira. We know LOTS of kids who were put on Remicade before Humira for their IBD. My daughter has a friend (the one who developed stricturing disease) and her preference is trying Humira, but insurance and her GI prefer Remicade. I think it's still used more frequently in IBD than Humira (though both are very effective drugs) and honestly, being able to dose by weight and to change the frequency is a huge advantage.
Also, you can avoid immunogenicity in two ways - one, by therapeutic drug monitoring and making sure your son's trough level of Remicade is where it should be. The other way is adding an immunomodulator like Methotrexate - you typically need quite a low dose just to prevent antibodies (and a higher dose if you're using it therapeutically). For example, if you're using MTX to prevent antibodies, you get away with just 7.5 mg, whereas if you're using it to control disease, it's typically higher - between 15 mg and 25 mg. I have one daughter on 15 mg and the other daughter is on 20 mg, both in addition to biologics. The younger one is on 15 mg of MTX (which we're really using to control her arthritis as well as preventing antibodies) and Remicade. Additionally, sometimes upping the dose of biologics (again to keep the level in the blood steady) can help out-compete antibodies if they're there.
There also have been cases of kids having antibodies and then increasing their dose of Remicade or adding MTX and then the next test showed that there were no antibodies. I think this is @pdx
's daughter if I am remembering correctly.
Remicade is more likely to cause antibodies because it's murine - mouse protein. Humira is a humanized protein. So sometimes you will see or hear doctors say that once you're on Remicade, you use it till it stops working because if you stop it, you're more likely to have an allergic reaction or build antibodies to it if you try it again. However, my daughters have been on Remicade multiple times, both without having any issues at all.
My younger daughter has been on Remicade 4 separate times (and has never tested positive for Remicade antibodies). Her arthritis is severe enough that we have tried and failed pretty much every drug option, including combinations of two biologics. So we are re-trying Remicade. She does need a higher dose and more frequent infusions since she has been on it before - she's on 10 mg/kg every 4 weeks. No side effects except she's a little tired the day after the infusion. I will say that when she was in college, she found Remicade infusions somewhat annoying because she had to miss class, however, there are now a lot of kids who have Remicade infusions done at home (or in a dorm!) with a home health nurse.
My daughter has not done Remicade at home, but has done other infusions at home and LOVED it. Remicade has always worked very well for her Crohn's - every time she's been on it, it's put her into remission in months. She recently had completely clean scopes last summer after being on it for 6 months!!
I will also say that my daughter was on experimental high dose Remicade for her arthritis - 20 mg/kg every 4 weeks. I was absolutely terrified of infections and side effects, but she was absolutely fine. No issues at all!
My girls did find Humira more convenient in college - 10 seconds and you're done. One preferred using the auto-injector and the other a syringe. The shot doesn't hurt anymore - it used to be very painful because it has citric acid/citrate in it as a preservative -- just in case you search old posts, you may see a LOT of kids (and adults) found that the pain of the shot was very hard (it really burned when injected). However, now Humira does not have that preservative, so it's relatively painless. But there are biosimilars of Humira coming, and some of them do contain citrate or other preservatives (I have been told that the one biosimilar Amjevita that is on the market already has acetic acid and therefore burns some when injected). I just wanted to mention it because you had said one of your son's did not like injections (or maybe it was just injecting himself?).