When Remicade does not work any more, what drug should I try

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linclan5
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Joined: Sun Jan 02, 2011 6:22 am

When Remicade does not work any more, what drug should I try

Post by linclan5 » Thu Apr 04, 2013 12:19 pm

I had been on remicade for Panuveitis for 18 months, and I had no side effects and I has absolutely no uveitis symptoms. I had i.v. treatments every 6 weeks for a year, then every 8 weeks for a while, and then when I went to every 10 weeks my uveitis came back. After the flare up I had injections of steroids under each eye to calm the flare somewhat, and I had one normal remicade treatment at 7 weeks and went on 15 mg methotrexate a week. That did not work, so six weeks later my doctor has tried upping the dosage of remicade by about 40% in addition to the staying on the methotrexate. I emailed Dr. Foster and he agreed with this course of action. Today is three days after the upped dose and 7 weeks after I started on methotrexate, and I feel like I still have active uveitis, although on a lower level than I had it before the injections. My brother, who is a gastointerologist, says that his chrohns and colitis patients sometimes develop a resistance to remicade if they go off and try to go back on again, and my opthomologist agreed that that sometimes happens. When I first went on remicade I think it worked right away; how long should I wait to see if my uveitis goes away before I try a new drug? My rheumatologist wants me to have another high dose 4 weeks after the first high dose, and then he will consider Humira if the remicade does not work. If I continue to have a low level of uveitis, should I wait the full 4 weeks and have another high dose of remicade and see if that works before considering a different drug? Is Humira the drug of choice after Remicade? Many thanks for your advice.

Mike Bartolatz
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Re: When Remicade does not work any more, what drug should I try

Post by Mike Bartolatz » Thu Apr 04, 2013 2:06 pm

I'm not a doctor but the suggested things are most likely correct.
do you have an identified condition causing your pan uveitis?

Wish you the best,
mike
Mike Bartolatz
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linclan5
Posts: 14
Joined: Sun Jan 02, 2011 6:22 am

Re: When Remicade does not work any more, what drug should I try

Post by linclan5 » Sun Apr 07, 2013 9:50 am

I have some very minor arthritis ymptoms. I tested positive for a gene named hl1dr7, which has been linked to psoriasis and psoriatic arthritis, so my rheumatologist beleives that my underlying condidtion is psoriatic or spondylo arthrits.

Mike Bartolatz
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Re: When Remicade does not work any more, what drug should I try

Post by Mike Bartolatz » Sun Apr 07, 2013 2:31 pm

any symptoms of celiac disease? http://en.wikipedia.org/wiki/HLA-DR7
have you tried cutting out wheat and anything with gluten in it?
any testing to see if you have other markers such as the HLA B27 gene? more often found with uveitis?


take care,
Mike
Mike Bartolatz
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linclan5
Posts: 14
Joined: Sun Jan 02, 2011 6:22 am

Re: When Remicade does not work any more, what drug should I try

Post by linclan5 » Sun Apr 07, 2013 7:12 pm

I am Hal b27 negAtive, and I have tested negative for celiac disease. I have tried cutting out gluten as well, but it has not helped.

Mike Bartolatz
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Joined: Fri Feb 06, 2004 9:58 pm

Re: When Remicade does not work any more, what drug should I try

Post by Mike Bartolatz » Mon Apr 08, 2013 11:26 am

it might be that another biological such as Stelara might help since you are thought to have psoriatic arthritis present. they could test you for the IL23R gene to see if it is present along with your other gene predisposition. Stelara blocks the IL 23R gene frequently found in psoriasis and many other inflammatory disease processes. the IL23R gene triggers TNF A production so blocking this gene could stop the inflammatory response IF it is present.
this gene is also seen in Ankylosing spondylitis, autoimmune thyroid disease, crohn's disease, lupus, sarcoidosis etc
wish you the best,
mike
Mike Bartolatz
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