Jan regarding my last post to you... 2 questions

Does entivyo act like steroids in its ability to treat my PG and EN?

Does entyvio act like remicade in healing fistulas?

Thanks again!

From what I was able to glean from the literature, Entyvio is different than either steroids or biologics. The end result is similar, with a blocked inflammatory process. Steroids work all over the body in a more global sense and are damaging to your organs, eyes, etc. biologics mostly block TNF-alpha molecules from entering the inflammatory cascade. Entyvio blocks white blood cells from entering the gut and participating in the inflammatory response.

My first question is why not Remicade, Humira, or Simponi, since they have been in the pipeline longer?  The other question is whether your insurance will cover it without failing at least one of those other options? It may be the next best thing since sliced bread, I don't know. But, I would be asking my GI about those questions. He may have perfectly good reasons. I will tell you, though, I would personally want to shy away from IV infusions and opt for injections I can do myself, unless there was a compelling reason. 

I do agree with your doc that you need to be more proactive and treat your gut more agressively so you are not dealing with the PG/EN on a recurring basis (a sign of poorly controlled gut inflammation).

Jan

Jan thank you so much for your response. Just 2 few short related questions.

Why do you suggest opting for medication such as humira that I can inject myself rather than biologic infusions... is it because they are safer or is it a matter of convenience or expense or efficacy of the particular drugs involved? (Also pertinent  is the fact that my veins are extremely uncooperative and usually require the anthesiologist to start the IV for pouchoscopies after 4 or so attempts by the tech or nurse). Secondly, although the research and assumption tends to be that outbreaks of PG/EN are a manifestation of increased infalmmatory process in my pouch, this tendency does not seem to apply to me.  Even when my pouchitis symptoms are non-existant and I feel good, I still get outbreaks, and the converse is also true...when my pouchitis is active and I feel crappy, I do not necessarily get PG/EN. Is this possible? Having frequently used kenalog shots/steriods to treat my outbreaks, my Derm mentioned the consideration of treating it with cyclosporin instead.  How would this flow with the other meds my GI may put me on at my next visit wednesay a.m. I will also be asking him about the possibility of Uceris instead of the infusions .  What can I expect from the cyclosporin... are there many risks involved?

For me, part of it is convenience. Self injection avoids the inconvenience and time waste of an office visit and time it takes to infuse. With self injection, you inject at home at your convenience. I've been on biologics for ten years and that would be a lot of office visits and time sitting there!

And, yes, giving your veins a rest is a good thing too. Not to mention that it is cheaper for you (no office copay) and for your insurance company. I am always for the most cost effective options, and not necessarily the ones that provide extra billings for the doctor's office.

But, I don't think the infusions are less safe per se, other than the risks associated withvein damage and possible acute allergic reaction (as the drug becomes systemic immediately).

It does sound like your peripheral skin lesions manifest independently from your gut inflammation, so I'm not sure how that might change or affect your treatment.

Jan