Is the point of the top down approach to start with the top drugs (biologics) and then, once remission is reached, try to go down the pyramid to a lower level drug for maintenance? Or is t just that you start at the top and stay at the top? I keep seeing these two terms mentioned, but am not quite sure the theory behind them.There is a treatment pyramid
So you can do bottom up theory where they GIVE you the least effective (but lowest risk meds first ) and work up from there
More GI are now starting with top down theory
They use the most effective drugs (highest risk though first )
But some still have insurance guidelines
Whiich require the cheapest (bottom of the pyramid) first before moving up
http://www.hopkinsmedicine.org/gast...pdfs/small_large_intestine/crohns_disease.pdf
Ds started
1.) on pentasa(5-asa)-failed
2.)Then 6-mp (failed)
3.)Plus asacol (another 5-asa) failed
4.)mtx failed
5.)remicade -reaction
6.)-now humira plus mtx
So up the pyramid one step at a time
Is the point of the top down approach to start with the top drugs (biologics) and then, once remission is reached, try to go down the pyramid to a lower level drug for maintenance? Or is t just that you start at the top and stay at the top? I keep seeing these two terms mentioned, but am not quite sure the theory behind them.
I am also being treated with the bottom up method, and it's not really working too well. My doctor kept assuring me that my case is mild, and that I wouldn't need any further drugs, but that doesn't seem to be the case. The lialda isn't working, and I just want to go back to the way I was before all this started. I think a biologic could definitely help me for the time being, but I'm not loving the idea of staying on one forever. I see people run through these meds and then end up with no options. The prospect of that is terrifying.I'm also wondering this! I'm clearly being treated with the bottom up methodology but if I do go on a biologic I think knowing the NHS finances they would put me back on something cheaper once in remission. I know someone who couldn't tolerate azathioprine so went on remicade, but then once in remission she could tolerate azathioprine again so she's been on that ever since.
My understanding is that in the states once you go on a biologic you stay on it unless you develop any problems? I'm sure I've seen that on a previous post.
I am also being treated with the bottom up method, and it's not really working too well. My doctor kept assuring me that my case is mild, and that I wouldn't need any further drugs, but that doesn't seem to be the case. The lialda isn't working, and I just want to go back to the way I was before all this started. I think a biologic could definitely help me for the time being, but I'm not loving the idea of staying on one forever. I see people run through these meds and then end up with no options. The prospect of that is terrifying.
Today is just one of those days where I want to crawl into bed and not come out until someone finds a cure for the terrible disease lol.
I am wondering if you might need a second opinion.I am also being treated with the bottom up method, and it's not really working too well. My doctor kept assuring me that my case is mild, and that I wouldn't need any further drugs, but that doesn't seem to be the case. The lialda isn't working, and I just want to go back to the way I was before all this started. I think a biologic could definitely help me for the time being, but I'm not loving the idea of staying on one forever. I see people run through these meds and then end up with no options. The prospect of that is terrifying.
Today is just one of those days where I want to crawl into bed and not come out until someone finds a cure for the terrible disease lol.
I thankfully have an appointment with a new GI tomorrow morning. She's the head of the IBD department at the local university hospital. I'm hoping I'll be getting things straightened out soon! ThanksI am wondering if you might need a second opinion.