Treatments for Crohn’s - Colon and Small Intestine Affected

[Jandersen20]

Hello,
In your experiences, what treatments/Biologics are used when there is mostly colonic inflammation with some small intestine inflammation?
My son has severe colonic ulceration and most of the information is in his colon, and he also has a lot of inflammation in his rectum. I’m trying to find out exactly what part of the small intestine is affected, but I don’t believe the TI is involved.
I understand some Biologics work better in certain areas. What happens when multiple areas are affected? Right now he’s on Humira, but he’s flaring so it doesn’t seem to be working as well. Waiting for results to see levels of Humira.
I’m curious if anyone else has experience with both the large and small intestine being affected and what Biologic(s) would typically be used.
Thank you!

 

[Maya142]

All anti-TNFs work for both small and large intestine - Remicade, Humira, Cimzia. Stelara is an IL-23 and IL-12 inhibitor and I have heard it said that it tends to work better for small bowel disease BUT it is also approved for Ulcerative Colitis (which is only found in the colon), so it must work for disease in both the small bowel and the colon.
Entyvio is also approved for both Crohn's and UC but all the GIs we have consulted have said it works best in the colon and not so well in the small bowel.
Sometimes GIs will combine two biologics, such as Humira and Entyvio if the Humira is not enough to control the colonic disease, for example.

I'm going to tag @crohnsinct because her daughter has been on two biologics for severe Crohn's.

 

[crohnsinct]

Yep! Maya pretty much summed it up. The mist successful drugs for both small and large are Remicade and the Humira. After that colon would go to Entyvio and Stelara for small bowel.
My daughter has disease in her TI and throughout her colon her sigmoid and rectum being the worst. After she failed Remicade she went to Entyvio. Entyvio didn’t work for her colon and her TI started flaring so we added Humira. If it was just her TI, we would have added Stelara but since we needed to help the colon we went with Humira.

Don’t give up hope yet with Humira. There might be something you can do. I forget is he on weekly doses?

Did he do a round of steroids or EEN?

When my daughter was first diagnosed she started in Remicade. 4 month later she was still steroid dependent and the doc wanted to add methotrexate. She opted for a round of EEN. The EEN got her to remission and we were able to hand Remicade a healed colon and it was able to keep her in remission for about 2 years.
My point being that sometimes it’s just an uphill battle for these drugs and they can’t get the kids to remission and keep them there without some early intervention (steroids, EEN).

I hope this helps.

 

[Jandersen20]

Thank you so much for the replies!
My son did a round of Prednisone right after he was diagnosed. Then, he went right on Humira. Been on Humira since July and he’s flaring. The only symptom he had prior to diagnosis was bleeding. Now he has bleeding (a tad better than before Humira), frequency, and urgency.
He just started Uceris Foam to see if that helps with the urgency. We should hopefully get Humira levels back this week so we know where to go from here.

 

[crohnsinct]

Sometimes the overlap between the steroids and the maintenance drug is too short and you have to taper much more slowly to give the maintenance drug a chance to grab on.