Chronic inflammation can lead to problems (e.g. strictures), so the GI’s concern is understandable. The Remicade idea is reasonable, but there can sometimes be issues restarting Remicade after a lapse. The surgeon’s hesitation may be that introducing medication when someone is feeling fine sometimes makes them feel…less fine.

Hi Scott,   I took Remicade for about 2.5 years beginning in 2012.  I developed antibodies, so the doc stopped it.  I don't remember why we didn't move on to a different biologic.  Would you elaborate on the "feeling fine" issue?  My surgeon also wondered why Entyvio and not another biologic?  I think when the Calprotectin results come back, I would like both docs to weigh in on the next step.  I'm very nervous.  

Thanks!

It can seem like a good idea to get two opinions instead of just one, but in many cases it can just make things more unsettled and anxious. Your GI is probably more aware of the trade-offs between biologics, but the choice will usually be partially arbitrary. I think I’d go with the GI’s advice - Entyvio is a fine thing to try, and if it turns out not to be right for you you can try a different one. The surgeon has taken good care of you for a long time, and it can be hard to give that up. Remicade is likely off the table, given your antibodies.

The reason why Entyvio is sometimes favored as a second choice after the failure of Remicade is that it's mechanism of action is completely different from Remicade. I have never developed any antibodies to Remicade and still use it, but need to supplement it with antibiotics. I developed a stricture when I went off antibiotics and now I am back on. I am told that Entyvio is my backup plan if Remicade at some point is deemed to have failed.

thank you!