Treating a fistula: Is one biologic better than the others?

[danmc]

A few weeks ago I met with my colon-rectal surgeon and a PA to discuss treatment for Crohn's, and a fistula that isn't healing.

The CRS said that because the fistula wasn't healing I would definitely need a biologic to heal it.

The PA is the one who specializes in the Crohn's treatment and what she did was give me pamphlets and other materials for Humira, Remicade, and Cimzia and basically said "Take these home and read them and make a choice."

She didn't give any guidance on my particular situation and which one might work better in my case.

Is this typical? I know that there are differences between how the biologics are administered, i.e. Remicade is transfusion and Humira is self-administered shots, but besides that aren't there differences particularly for the treatment of a fistula?

thanks
Dan

 

[ronroush7]

I have been on four of them so far and my GI has been the one to say which one to try.

 

[danmc]

Yes, I would expect the doctor to give some guidance at least. Throwing pamphlets at me and asking to read up and make my own choice seems bizarre to me.

 

[ronroush7]

It would seem like the doctor would have an opinion.

 

[JaimeM]

From what I've read remicade does a great job of healing fistulas. Cimzia not so much

 

[danmc]

Prior to joining this forum (I was only diagnosed with CD end of last year) I didn't know anything about the treatment except for a little bit of reading on the internet. After joining this forum, which is a great resource, it seems to me that people prefer Remicade over the others for fistula treatment. Which is why it surprised me that the CRS PA seemed to think that any was as good as the other.

Granted, I understand that sometimes one of the biologics will not work for someone and therefore that person would need to move onto another, but I would think there would be some kind of protocol dependent on symptoms.

 

[danmc]

I saw the PA at the GI office today, and we decided on going with Humira. She thought, based upon what she has read and her own experience, that either Humira or Remicade should be good for treating CD with a fistula, but she asked one of the MDs and he said his own personal experience was that Humira worked better.

Of course if Humira doesn't seem to do the trick I'll try Remicade.

 

[northwesterner]

Generally - Remicade>Humira>Cimzia

 

[ronroush7]

I saw the PA at the GI office today, and we decided on going with Humira. She thought, based upon what she has read and her own experience, that either Humira or Remicade should be good for treating CD with a fistula, but she asked one of the MDs and he said his own personal experience was that Humira worked better.

Of course if Humira doesn't seem to do the trick I'll try Remicade.

Wishing you the best.

 

[Enok Root]

The PA is the one who specializes in the Crohn's treatment and what she did was give me pamphlets and other materials for Humira, Remicade, and Cimzia and basically said "Take these home and read them and make a choice."

I just had the same thing happen and thats why I here! I'm on Remicade but the cost is killing me. SO my Dr gave me brochures on Cimzia and Humira and basically said to call my HI to find out costs and left the final choice up to me.

 

[ronroush7]

I just had the same thing happen and thats why I here! I'm on Remicade but the cost is killing me. SO my Dr gave me brochures on Cimzia and Humira and basically said to call my HI to find out costs and left the final choice up to me.

Humira has been only five dollars every time for me. It has only been two months so far that I have been on it and I am hoping for good results. Check with your insurance. Cimzia was great at working on my intestines but eventually stopped working.

 

[danmc]

I just had the same thing happen and thats why I here! I'm on Remicade but the cost is killing me. SO my Dr gave me brochures on Cimzia and Humira and basically said to call my HI to find out costs and left the final choice up to me.

Luckily my prescription med insurance will cover all of the Humira for me (at least that's what they said on the phone, you know how those things work out sometimes!)

I never did find out what the Remicade coverage is. If the Humira doesn't work though I'm sure I'll find out.

 

[ecrohns1995]

A few weeks ago I met with my colon-rectal surgeon and a PA to discuss treatment for Crohn's, and a fistula that isn't healing.

The CRS said that because the fistula wasn't healing I would definitely need a biologic to heal it.

The PA is the one who specializes in the Crohn's treatment and what she did was give me pamphlets and other materials for Humira, Remicade, and Cimzia and basically said "Take these home and read them and make a choice."

She didn't give any guidance on my particular situation and which one might work better in my case.

Is this typical? I know that there are differences between how the biologics are administered, i.e. Remicade is transfusion and Humira is self-administered shots, but besides that aren't there differences particularly for the treatment of a fistula?

thanks
Dan

Hi,
I've had fistula's for the last 5 years, was discovered after having an abscess. Infliximab infusions have been brilliant at healing fistula tracks that are not so well formed however it has failed to heal/eliminate symptoms from the main fistula track that has had various setons in place. I have recently just had surgery to have a look at the track however after all this time it still hasn't healed enough (come out of the sphincter muscle) to be cut out/laid open or plugged with collagen.
I am now going to try Humira in a few months after recovering from the op. I would say give infliximab (with azathrioprine tablets) ago first as this is 'apparently' the best course of treatment to start with for fistulas.

Good luck in making your descision!

E

 

[danmc]

We are going to start Humira soon.

Unfortunately I was found to have a C. Diff infection and am going through Vancomycin treatment right now.:yfrown:

Dan

 

[ronroush7]

We are going to start Humira soon.

Unfortunately I was found to have a C. Diff infection and am going through Vancomycin treatment right now.:yfrown:

Dan

I am sorry.