There is no limit on the amount of time a patient can take Remicade (infliximab). The drug has been available since 1998, and many patients have been successfully treated and have been on Remicade for more than six years. Of course, the longer you take Remicade, the more immunosupressed you are — that is, less able to fight off infection — and the more risk you run of opportunistic infections. Opportunistic infections don’t usually affect people unless they are immunosuppressed, but they are usually serious. So your son should probably continue to take Remicade until he and his doctor feel that it is no longer effective on his Crohn’s disease or until a complication develops. If his doctor has advised him to switch to a different medication, your son may want to explore the doctor’s reasoning and get more information before making the decision to quit taking Remicade. Q2. My son is 25 years old and was diagnosed with moderate to severe Crohn’s disease at 19 years old. He has undergone two bowel resections and an ileostomy. One year ago the ileostomy was reversed, and the Crohn’s flared up. He spent most of two months in hospital and then began Remicade treatments. He has been experiencing symptoms again, and his gastroenterologist suspects he is developing a resistance to the Remicade and is beginning yet another flare-up. Some tests are scheduled but he has been advised to research options to be prepared for a change of treatment – Imuran with Remicade, methotrexate and Remicade, increasing the Remicade or more surgery as a last resort. Financially, increasing the Remicade is impossible and would quite possibly be useless if he is developing a resistance. The Imuran and methotrexate are frightening, but of the two which one carries the least risk while being effective? Could he start with one and move on if necessary? He was on the Imuran alone for a couple of years and never reached remission. Please advise. Some patients develop antibodies against Remicade (infliximab) over time, so the medication loses its effectiveness. When Remicade fails to help people with Crohn’s disease, other biologic agents are available and effective. The alternative biologics that are approved for Crohn’s disease are Humira (adalimumab), Cimzia (certolizumab pegol) and Tysabri (natalizumab). Like Remicade, both Humira and Cimzia block an inflammatory substance called tumor necrosis factor (TNF). Both are injected under the skin. Tysabri, which is given intravenously, binds to a protein on the surface of certain white blood cells to prevent them from leaving the bloodstream and entering into tissues where they would otherwise cause inflammation. You don’t mention these other biologic options in your question. So if your son’s physician is unaware of these other therapies, please seek a second opinion. Adding methotrexate or Imuran (azathioprine) to Remicade is probably not a good idea in this situation since the benefit is low and the potential risks from combined immune system suppression are high.
Q3. I have three perianal fistulas due to Crohn’s disease with the first one occurring in November of 2007. I have had three setons for five months now. I had two small bowel resections in 1986 and 1996. Recent tests show a short bowel with 50 percent of intestine removed plus severe disease in the descending colon and disease in the rectum but to a lesser degree. Prior to the first fistula, my Crohn’s was only at the terminal ileum and never in the large intestine. I just had my second Remicade infusion and the fistulas are still draining greenish pus quite a bit. After the first infusion, they seemed to slow up a bit but not now. When I can expect full closure of the fistulas with Remicade? Is it normal for the fistulas to drain so much after the second infusion? Isn’t Remicade a sure thing to close perianal fistulas so I can have the setons removed? Once the fistulas are closed, they won’t come back – right? Thank you. Only about half of patients with perianal fistulas who get Remicade (infliximab) have complete closure of fistulas. Those who respond should see a marked improvement by the third Remicade infusion. We don’t know why some patients fail to respond to Remicade, but incomplete drainage of pus in the perianal area is one possible explanation. Even with successful therapies, fistulas tend to come back and aggressive maintenance therapy for maintaining remission is usually warranted. Learn more in the Everyday Health Crohn’s Disease Center.
