Trying Humira first?

Hi friends,

About 8-9 years ago, I was diagnosed with Crohn's. I was given Asacol and it went into remission, so I quit taking it after about 2 months. I didn't realize that I was supposed to take it forever and I felt better, so it seemed the right thing to do.

About two months ago, I went to my Primary Care Dr for odd, random pains that didn't seem to make sense. He did bloodwork, found I was anemic, figured this may be related to the old Crohn's diagnosis, and referred me to a new GI doctor.

So, Aug 7, I have my colonoscopy and find that the Crohn's is worse. Inflammation in all parts of the colon. I'm put on 40 mg Prednisone and Lialda. Immediately I feel better. I try to taper the Prednisone, but each time I taper, my stools lose their form, so I'm bumped back up.

At my follow-up appointment earlier this week, my GI doc tells me that he wants me to try Humira. He says that new studies show that rather than starting other meds first and transitioning to Remicade/Humira if those don't work, it's now recommended to call in the big dogs from the start. So, assuming my insurance approves everything, I should be starting next week.

Everything I've read on Humira's site, on forums, and everything else I can find, still indicates that Humira should only be used if nothing else works. Has anyone else heard this? He's a very reputable GI doctor in my area, and I trust him, but it just goes against what I've read.

Thoughts?

There are two schools of thought, the bottom up approach and top down approach. The reasoning behind top down is to hit the inflammation hard and achieve mucosal healing in an effort to stave off further progression. Whereas, with bottom up you move up in meds if/when the last med fails.

My son went straight to remicade so top down approach but there are loads who have followed the bottom up as well. There have been comparative studies on the approaches, I'm on my mobile or I would post them.

If you are uncomfortable with top down you could speak with your GI about bottom up approach. Good luck with which ever treatment plan you choose!

Clash,
Thank you very much for the quick and GREAT response. I was able to search top-down approach for Crohn's and find so much more information that supports what my Dr is wanting to try. Again, thank you!

If asacol worked for you, why not ask the dr about azathioprine. I was on it for years and it worked well. Personally I would rather work up than down. Im now on humira and sulphsalazine. As nothing else seemed to work.

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