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Starting Stelara

It's been a long time since posting here. I have been on Entyvio since February 2018. Entyvio is slowly failing me. I've had severe diarrhea. Including wearing depends. Had a CT scan. Which found inflammation in the colon. My GI's PA has started the process of getting Stelara approved. The insurance has been playing Doctor. We were denied when we requested entyvio every 6 weeks. I am waiting to hear if they approve Stelara.
 

Scipio

Well-known member
Location
San Diego
Good luck with your insurance. I've been pretty pleased with Stelara since starting it more than 5 years ago. My Crohn's is not completely abolished by the Stelara. There is still some residual inflammation in the ileum that is detectable by colonoscopy and occasional brief bouts of minor pain in the same location. But except for that I'm able to lead a normal, Crohn's-free life thanks to the drug.
 

my little penguin

Moderator
Staff member
Same here -my kiddo started Stelara in 2017
Insurance required every 8 weeks for 8 months and new scope/imaging to prove it wasn’t enough in 2018
Switched every 4 weeks after proof from scopes /imaging
Same issue three years later insurance required proof he still required every 4 weeks
Ds tried 6 weeks per Gi request
Small flare /fecal cal /bloodwork etc
So insurance approved 4 weeks again
Hopefully it works well for you and insurance approves it soon
Good luck 🍀
 
Well guess what? My insurance has denied Stelara. They are requiring that I go on Renalsis, a Remicade biosimilar. If after 8 weeks that hasn't worked they will approve Stelara. I hate insurance companies.
 

my little penguin

Moderator
Staff member
Ugh…
Have you ever been on remicade or humira before ??
I know for ds we had to step up therapy for insurance and fail each and every one of them
From 5asa’s ,immunosuppressants, and then each biologic
At least it’s only 8 weeks
Remicade might work
Ds was only on that one 8 months
Worked well -just had two back to back allergic reactions so ….
 
The first biologic I was on was Humira. In 2018 it failed due to antibodies I built up. At that time my Dr told me he would not prescribe Remicade because it is also a TNF blocker and the antibodies would work against Remicade as well.
 

my little penguin

Moderator
Staff member
My kiddo had an allergic reaction to remicade x2 (antibodies against it we were told )
But was still able to take humira without issues for 5 years after that until it stopped working
So maybe remicade will work ..
 

my little penguin

Moderator
Staff member
One thought
You could ask Gi for antibody test for remicade
Odds are it will be negative
But if positive the doc could push back on possible allergic reaction
Antibodies are to the protein
They use to put the anti tnf on
Humira is some other weird thing but humanized further (hence humira name )
Remicade is murine protein (mouse ) - has actual mouse dna
Remicade has much higher antibody allergic reactions due to the mouse protein
 
You should be able to appeal and win by giving them evidence that you tried Humira and that it failed. You may also need to point out that Remicade and Humira both have the same mechanism of action.
 

Maya142

Moderator
Staff member
The first biologic I was on was Humira. In 2018 it failed due to antibodies I built up. At that time my Dr told me he would not prescribe Remicade because it is also a TNF blocker and the antibodies would work against Remicade as well.
I have never heard that before - that antibodies to one anti-TNF will work against antibodies to another. We've always been told that antibodies are very specific. My daughters have both been on multiple TNF inhibitors and they all worked for some time - sometimes for years. My younger one started Remicade for the 4th time 6 months ago (she ran out of drug options), and while she has needed a high dose, she is doing much better on it - both her arthritis and her IBD. She has never had an allergic reaction to Remicade and her antibody tests done in the past have been negative. We'll be doing an antibody and levels test with her next infusion, so we'll know if she's developed them.

But she does have antibodies to a different anti-TNF - Cimzia. Her GI upped her dose of Cimzia to counteract that, and it worked for a while. But her Cimzia antibodies haven't caused Remicade to not work. Before newer biologics like Entyvio and Stelara were approved, it was common to use drugs with the same mechanism. Your chances of responding to a second anti-TNF are somewhat lower than the first, but plenty of people respond well to the second anti-TNF too. My older daughter did very well on 4 anti-TNFs before moving to a biologic with a different mechanism.
 
In general, the insurance requirement is that you must have tried and failed Humira or Remicade (or biosimilar) before trying Stelara. Usually they do not require patients to try both Humira and Remicade before moving to Stelara if their doctor is prescribing Stelara. Usually there is also no requirement to prove exactly why it failed.

So, evidence of a trial and failure of Remicade is usually enough to get around a requirement to try Humira first. If the insurance requirement is specifically that patients must try Humira first, you are likely to be able to get around this by showing the prior Remicade use since they are both anti-TNF.
 
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