Need help. Best medication Pentasa or Humira?

I am a 64-year-old male. I have recently been diagnosed with Crohns after an MRI scan. Although, I don't seem to have the symptoms that seem to be prevalent amongst Crohns sufferers. I would say my situation is very mild to the point of saying I thought I had just odd bad days with the tummy. Anyway, I have been prescribed 2 x 500mg twice a day of Pentasa. I am finding that this makes me fee not well,l very dizzy and groggy since taking them. I also have Ankylosing Spondylitis for 40 years. For the AS, I being treated with the Anti-TNF drug Embrel. My question is, would I be better off switching to an alternative Anti-TNF treatment such as Humirarather than taking Pentasa? As I'm already taking an Anti-TNF treatment. I understand that Humira is a very effective treatment for Crohn's. My next appointment is not for another month, but wanted to get as much info on the subject before asking the question. Any advice or info would be much appreciated. Thank you

I am sorry you are having trouble. I was on Pentasa for a short time but never Humira so far. Hopefully , someone will be along shortly who can help. Let us know how you are.

Tagging Maya142

Enbrel is typically not used in someone with crohns since it can make it worse
Pentasa is Not approved for treatment of crohns since it only fixes the top layer and crohns affects all layers

Humira can be very effective for both
Ds has JSpA and us on the combo of humira plus Mtx
( he has arthritis in his hands as well as other joints so far it has not progressed to JAS)


I would definitely discuss it with your Rheumo and Gi
Co management is tricky

It can be a dangerous situation to be on 2 anti-TNFs. There is such a thing as PML (Progressive multifocal leukoencephalopathy), a brain infection whose mortality rate is very, very high. Different biologics shouldn't be taken at the same time for this reason. Taken together can cause very serious and life threatening side effects.

Salad shooter
Typically you are switched off one anti tnf such as enbrel and started on another humira when you go from one dx to two dx which both benefit from anti tnf

They don't give two anti tnf at the same time

my little penguin said:

Salad shooter
Typically you are switched off one anti tnf such as enbrel and started on another humira when you go from one dx to two dx which both benefit from anti tnf

They don't give two anti tnf at the same time

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That's exactly what I said. Andydem asked about switching from Pentasa to a biologic. He's already ON a biologic (Enbrel for AS). I was cautioning him about being on 2 biologics.

The question from Andyem:......."For the AS, I being treated with the Anti-TNF drug Embrel. My question is, would I be better off switching to an alternative Anti-TNF treatment such as Humirarather than taking Pentasa?"

I would assume his rheumatologist would intervene and state that for him to switch to humira he would need to come off the enbrel as I'm also sure his GI would when he explained the situation.

There are some with 2 dxes that require 2 biologics but usually have severe conditions. Although, many fear not PML but a heightened cancer risk there are also now meds in the pipeline that act as a double biologic. My son's GI just attended a conference where one of these meds was being discussed.

My daughter also has AS and Crohn's. She was diagnosed with juvenile spondyloarthropathy at 12 and it progressed to AS when she was 16. She was also diagnosed with Crohn's at 16. At the time, she was on Enbrel.

Her Crohn's was not severe, but her rheumatologist and GI agreed that since she was already on a biologic, it should be one that treated the AS and the Crohn's. Enbrel only treats AS, not Crohn's. So we switched to Remicade. She was also on Methotrexate, which treats both. Her Crohn's went into remission within 8 months or so, but her AS has been tricky. We are still trying to get it under control.

It's been a real nightmare getting her GI and rheumatologist to coordinate, but it's very important that both diseases get treated.

I agree that Pentasa isn't a good treatment option for most people with Crohn's. Some doctors say it's like taking aspirin for a brain tumor - just not very effective.

Humira, Cimzia and Remicade treat both AS and IBD. Simponi treats both AS and UC (not approved for Crohn's yet).

Good luck!

Wanted to add - Clash is right, very occasionally, doctors do use two biologics. We know there has been such a study at Boston Children's Hospital. But it's usually two different kinds of biologics - such as IL 6 inhibitor and anti-TNF or Entyvio + anti-TNF.

I don't think anyone would prescribe two anti-TNFs together - the risk of infection is too great.

Hello, pentasa is a very mild drug. In the UK it is still prescribed for crohns but is widely understood to be a bit like a band aid. It protects the wound but doesn't really heal it very well. Humira is a big step though, it is very effective for crohns but it does come with risks, due to this many doctors prefer to try using immunosuppressive medications like azathioprine or methotrexate before using anti tnf, especially if the disease is not very advanced. You can of course ask your doctor if they think humira or remicade would be appropriate for you but be prepared for them possibly wanting to try more conservative treatments first. Also remember that using the bigger medications now may mean you have less options later on.

Thank you all your advice on my issues. It's very much appreciated. As I mentioned, I am just starting on Pentasa prescribed for my Crohn's. But since taking them I feel awful, they are meant to be mild. I did previously mention that it was 500mg twice a day. I got that wrong, it's 2g in the morning and 2g in the evening. Also after having been on Enbrel for 3 years, it changed my life for better with hardly any back pain. But now after taking the Pentasa, it's come back with a vengeance!
No one seems to know why! To me, it's got to be the Pentasa reacting with the Embrel.

The reason I'm asking about Humira is that if I'm already on an anti-tnf treatment, I may as well be on Humira as treat both conditions.

I hope all that makes sense.

Thank you again for all your advice

Valleysangel92 is spot on:
Bone up on what the Pentasa is actually doing, particularly in relation to where your Crohn's is situated. Jumping straight to Humira seems a big step when there's Prednisolone/Budisonide in the short term and Azathioprine out there.

Biggest thing is to know what they all do and talk with your Dr. And don't be afraid to challenge them and question them on anything you're not sure of. Good luck.

Methotrexate and Azathioprine are not usually effective for Ankylosing Spondylitis that primarily affects the spine. I think that's why Humira is an option.

I agree with Maya
The poster is already on enbrel
So switching from enbrel which only help AS and can make crohns worse
To humira is very logical since humira treats both the AS and the crohns

Got it.

Pentasa is a pretty mild drug that can control Crohns for many people. It's not uncommon at all to be on Pentasa and an anti tnf. I would ask the GI why is he going to Humira so quickly? At the end of the day I would do what the dr suggests

Echodog the poster is already on a anti tnf biologic to treat his AS so switching to Humira which treats both AS and CD would mean he wouldn't have to address the AS with one immune suppression drug and the CD with another like imuran or 6mp. That's why he is thinking of humira.

Thank you for all your contributions. Clash you are spot on as to why I think I should go for Humira instead of Enbrel. Why be on two sets of drugs when you can be one on drug that does both jobs!

My Little Penguin mentions that Enbrel can make Crohns worse. Is there any more information on that, so that I can take that to my rheumatologist.

Also, quick side point, what is a GI? Here we have GPs as General Practitioners as in local doctors or doctors who specialise in certain conditions.

Thanks again

Echodog said:

Pentasa is a pretty mild drug that can control Crohns for many people. It's not uncommon at all to be on Pentasa and an anti tnf. I would ask the GI why is he going to Humira so quickly? At the end of the day I would do what the dr suggests

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Me too.

Etanercept has not been found effective for CD colitis [82], and further may increase the incidence of IBD in pediatric patients with JIA [83]. There is no data to date on the utility of Certolizumab or Golimumab for IBD associated arthropathy.

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From
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3261248/pdf/12178_2011_Article_9085.pdf


Gi is a specialist - gastroenterologist who knows the Gi tract

http://www.ncbi.nlm.nih.gov/m/pubmed/21459936/

Another article
Higher incidence of Ibd developing in kids with JIA who used enbrel