Use of Entyvio and TNF A blocker too

[Roxymusic]

Have any of you used Entyvio along with a biological such as remicade, Humira or cimzia? There have not been any trials, according to my gastro, and only some anecdotal evidence that a combination can work even better. Clearly, if it did, insurance would be a issue.

Both of them would not have been prescribed for crohns, but better crohns relief may have occurred.

 

[ronroush7]

I asked my doctor's office anout using both entyvio and Humira and they said no

 

[Maya142]

My daughter is on a combination of two biologics. She was on Entyvio + a biologic for her Ankylosing Spondylitis (not an anti-TNF).

Within two doses of Entyvio, she got drug-induced Lupus. Her GI had never seen drug-induced Lupus with Entyvio before and especially not that quickly, so she does wonder about it being the combination of biologics and not just Entyvio.

Now she is on an anti-TNF and IL-17. The anti-TNF is for her Crohn's, the IL-17 inhibitor is for her arthritis. So far, her Crohn's is definitely getting better, but her AS remains a mess.

 

[Maya142]

I wanted to add - her GI and rheumatologist only agreed to do this because she has severe Ankylosing Spondylitis and we had already tried anti-TNFs by themselves (Remicade, Humira, Simponi) for the AS and Crohn's. The Crohn's responded, but the AS didn't which is why we moved on to other biologics.

They were very hesitant to put her on two biologics but we had tried everything else to avoid it (MTX, Imuran, Imuran with Allopurinol, Entocort, Sulfasalazine etc) and nothing worked.

 

[my little penguin]

Two biologics are not recommended for the same disease
If one pathway is how the disease works in an individual then only one biologic is needed
If it's a different pathway
Then you need a different type of biologic
Not two

 

[Lady Organic]

I came across this ongoing study a while ago: Triple combo therapy phase 4:
Vedolizumab+Humira+methotrexate

https://clinicaltrials.gov/ct2/show/NCT02764762?term=crohns+montreal&rank=51
.

 

[Guerrero]

So far no guideline recommends the use of two biologics.
Maybe new studies or trial will help understand better if that could help.

 

[lgpcarter]

I saw my GI this week and he suggested a next step for me might be to add Stelara back in with the Entyvio and see what happens. My insurance company is going to love me!

We decided to up my Imuran to 225mg and see if that works before looking at Stelara again. I was on 50mg as a just in case thing to prevent development of antibodies to Entyvio, though more recent data shows antibodies are not a problem as they are with the anti-TNFs.

I don't have any drugs left to try, so adding Stelara to the Entyvio is a bit of a Hail Mary.

Not a lot of data on this combo yet, but he thought they had tried with a handful of patients in London, Ontario and expected to hear more about it at the Canadian Gastro meeting in February.

 

[ronroush7]

I saw my GI this week and he suggested a next step for me might be to add Stelara back in with the Entyvio and see what happens. My insurance company is going to love me!

We decided to up my Imuran to 225mg and see if that works before looking at Stelara again. I was on 50mg as a just in case thing to prevent development of antibodies to Entyvio, though more recent data shows antibodies are not a problem as they are with the anti-TNFs.

I don't have any drugs left to try, so adding Stelara to the Entyvio is a bit of a Hail Mary.

Not a lot of data on this combo yet, but he thought they had tried with a handful of patients in London, Ontario and expected to hear more about it at the Canadian Gastro meeting in February.

I have been told you can't combine biologics.

 

[lgpcarter]

They are starting to try: https://www.ncbi.nlm.nih.gov/pubmed/29250117

 

[my little penguin]

Ronroush
You can combine biologics
Ds is on two biologics (for different conditions)
Typically they don’t like too

Lgpcarter
When you were on Stelara before what was your dose and frequency

They have Ds on Stelara
90 mg every 4 weeks

Have you tried adding mtx instead of imuran
That may help

Our GI will not use entivyio for Crohns
They said it’s not effective enough
Only for UC do they see good results

There is also ivig which has had success in refractory Crohns cases

Stelara just takes six months to work
Can you do een (exclusive enteral nutrition- formula only ) no food
Until you get a med to work ???

There are il-23 only drugs that are in phase 111
Maybe compassionate use ????

 

[Maya142]

My daughter was on two biologics for a while. We might add Stelara to her current biologic (which works for arthritis but not IBD and is an IL-17 inhibitor).

I would also suggest MTX if Imuran hasn't helped in the past.

I am seeing a LOT more studies on combining biologics, especially Entyvio with an anti-TNF. They just have to have different mechanisms - you can't combine two anti-TNFs for example.

lgpcarter, I do know that there are lots of biologics in trials for Crohn's - definitely some IL-23 inhibitors that are supposed to work better than Stelara. There is one in Phase II trials I think. Risankizumab is the one I think.

 

[Lady Organic]

Igpcarter: I believe that if you have never tried Imuran at the maximal dose before (so only 50mg) and are now upping at 225mg, you have good chance of positive response Good luck!

 

[lgpcarter]

Starting Humira again as soon as it arrives. Will be staying on the Entyvio as well. Second patient they have tried it on in my city.

Will let you know how it goes! Bowel symptoms are pretty good at the moment, but fistulas still a big bother. Going in tomorrow for an EUA and new setons. Humira is to help fistulas. Fingers crossed!

 

[Anna's Bandit]

lgpcarter : I hope your new treatment plan is a success !
Keep us updated.

 

[Phartologist]

Be very careful when you up 6MP.... your white blood count can plummet and cause very severe blood problems.... my WBC dropped below 2.0 when the 6MP went to 100 from 50... the gastro dropped me back to 25 and I am weaning off 6MP entirely... the 6MP at the higher level is counter indicated for Entivio and n my case brought up 7 skin cancers.....BE CAREFUL:ghug::ghug::ghug:

 

[thike1966]

I go to a suport group led by a progressive doctor Who told us just last meeting that they are experimenting with combining Biologics and for example in Entivio takes a while to work because it actually worked prevents the replacement soldiers in the battle where Humira and Remicade block he front line soldiers, when the front has attrition there no replacements forces. It’s must make more calls complex, he puts things in very simple terms and using things as we can references make it easy to understand