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Crohn's Disease Forum » Ask the Experts » Do any of the biologics have a lower risk of infection?


01-04-2014, 12:42 PM   #1
David
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Do any of the biologics have a lower risk of infection?

A member recently asked,
Do any of the biologics have a lower risk of infection or are they all the same? Does decreasing duration between biologic dosing increase the chance of infection?
Tolulope O. Falaiye, M.D. of the Penn State Hershey Inflammatory Bowel Disease Center took time out of her busy schedule to answer this question. A little about Dr. Falaiye:

Tolulope O. Falaiye, MD is a pediatric gastroenterologist Hershey/Penn State IBD Center.

In regards to the question, Dr. Falaiye stated:

In May 2013, the American Journal of Gastroenterology published a study summarizing the findings of infections in all the studies of biologics. This summary concluded that less than 1% of patients on biologics develop a severe infection. But, in the research studies, patients on biologics were twice as likely as patients not on biologics to get a severe infection. In general, we believe the benefit of treating the inflammatory bowel disease outweighs the risks of the medicine. We do monitor for these infections and advise patients to stay away from people with active infections specifically of chicken pox, shingles and tuberculosis. At the current time, the medical community thinks the risk is the same for all the biologics. This is also what the pharmaceutical companies have stated.

When you say decreasing the duration between biologic dosing, I assume you mean spreading out the doses to get less medicine overall. We do not recommend this technique because in research studies, we found that patients who get the medicine too far spread out can become resistant to the medicine. If a patient becomes resistant to the medicine, they may never respond to the medicine again. So we usually start out with the medicine as far spaced as possible and give it more frequently only if a patient needs it more often to control their disease.
Thank you to Dr. Falaiye for her time and expertise!
11-25-2015, 08:07 PM   #2
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I attended a conference given by a Janssen medical director at Crohn's and colitis Canada and he stated that Stelara has a better safety profile than both Humira and Remicade.
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11-26-2015, 09:50 AM   #3
David
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Did he provide any reasoning as to why that might be?
11-26-2015, 07:23 PM   #4
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unfortunately, he didnt elaborate more than stating it or it is me who didnt understand more than that when I asked the question! But he was very affirmative with this statement. If Im correct, he did mentioned Stelara was not an anti-TNF, it was another kind of biologics targeting other molecules, but i dont recall which ones. Stelara has been on the market for over 10 years now and observations are from psoriasic patients and recently CD patient. Effectiveness has just been showed in CD (success rate similar to HUmira, but a little less than Remicade.)It is marketed by Janssen, just like Remicade.

I went to chat with him at he end and asked furthermore about Sterala. he then added combo therapy was not necessary with this drug for increased duration of effectiveness. It is not effective for Rheumatoid arthritis , but good for Spondyloarthritis. I dont know about UC, I forgot to ask.
11-26-2015, 08:10 PM   #5
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Thanks for elaborating, I appreciate it And good for you going to these conferences and educating yourself so much. Very impressive!
11-28-2015, 04:43 PM   #6
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unfortunately, he didnt elaborate more than stating it or it is me who didnt understand more than that when I asked the question! But he was very affirmative with this statement. If Im correct, he did mentioned Stelara was not an anti-TNF, it was another kind of biologics targeting other molecules, but i dont recall which ones. Stelara has been on the market for over 10 years now and observations are from psoriasic patients and recently CD patient. Effectiveness has just been showed in CD (success rate similar to HUmira, but a little less than Remicade.)It is marketed by Janssen, just like Remicade.

I went to chat with him at he end and asked furthermore about Sterala. he then added combo therapy was not necessary with this drug for increased duration of effectiveness. It is not effective for Rheumatoid arthritis , but good for Spondyloarthritis. I dont know about UC, I forgot to ask.
Stelara binds a particular protein that is used by two interleukins (Il-23 and Il-12). Supposed to inhibit NK cell activation as well as T cell differentiation and activation.

I've been looking around for why he'd say a better safety profile since I've got access beyond paywalls, but I haven't found anything yet.
11-28-2015, 04:57 PM   #7
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I guess it is from either unpublished or published data from Janssen of adverse side effects and allergic reactions. My question to him was:'' What about side effects and allergic reactions with Stelara compared to Remicade and Humira? Without hesitation, he stated: ''Stelara has a better safety profile''.
11-28-2015, 05:29 PM   #8
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Table 8: Infection history (Study C0168Z03: Incident Cohort)

In the study shows rate of serious infection is only 25% after 3 years on stelera but 31% on remicade

From
http://www.ema.europa.eu/docs/en_GB/...C500163376.pdf
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02-19-2016, 08:45 PM   #9
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rate of serious infection is only 25%
Serious infection in every fourth! I like their optimism with this "only".. =)
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Last edited by Zim; 02-19-2016 at 09:09 PM.
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