Posted by Dave on Jan 12, 2013
Remicade and Humira are similar drugs and both are TNF blockers. We know there’s too much TNF in the guts of Crohn’s sufferers, so why does Remicade work for some and Humira work for others? This seems really odd. If the drugs do basically the same thing, neutralize TNF, why don’t the drugs work for all Crohn’s sufferers with too much TNF in their guts?
To understand this situation better, think about this analogy. When I get a cold, I take paracetamol and it eases my symptoms, when my wife gets a cold she take Nurofen and it eases her symptoms. My wife has tried paracetamol for a cold and it doesn’t really help. So, we both can have a common cold (caused by a virus) but we use slightly different treatments to get symptom relief. Why does Nurofen work for some and paracetamol for others?
Although we know a lot about the human body, we are many, many decades from knowing everything. On the surface we have two arms, two legs, two ears, two eyes, a mouth and a nose, etc. But below the surface our anatomy is quite unique. The length of our intestines varies, the thickness of guts is not exactly the same, the amount of enzymes produced in our guts varies from person to person, the bacteria content of our bowels is different, etc. Also, human biochemistry varies from person to person: the expression of signalling compounds by cells probably varies slightly, etc.
So, our internal anatomy and individual biochemistry makes us very unique, which is likely to be determined, to a degree, by our DNA. Generally, this may explain why drugs work for some and not others, even for the same disease. Now let’s look at a specific example.
Humira may help some Crohn’s sufferers but not everyone, while Remicade may help the Crohn’s suffers that Humira can’t. Why? There may be number of reasons for this but let’s consider one.
In some patients, Humira causes an immune reaction. According to Abbot Labs (the manufacturers of Humira) the risk of developing a negative reaction to Humira is low, but a recent study has proven otherwise – 28% developed a reaction to Humira!
After three years, some 28% of patients developed antibodies to Humira, a sign of immune resistance. Patients with the antibodies had lower concentrations of Humira in the blood than those without antibodies, the researchers found, according to results published Tuesday in the Journal of the American Medical Association.
Patients with antidrug antibodies also had higher rates of treatment discontinuation due to treatment failure compared with patients with no antibodies (38% versus 14%), and lower rates of minimal disease activity (13% versus 48%) and sustained remission (4% versus 34%).
“The results of this study show that development of antidrug antibodies is associated with a negative outcome of [Humira] treatment in RA patients,” the researchers wrote. “Not only did patients with anti-[Humira] antibodies discontinue treatment more often and earlier than patients without … antibodies, they
also had a higher disease activity during treatment and only rarely came into remission.”
Read more: http://online.wsj.com/article/S..
Also, what the above study found is that when there is an immune reaction, Humira can make the disease worse. Here’s an example of when drugs go wrong.
I am a 37 year old Male diagnosed with Inflammatory Bowel Disease (specifically Crohn’s). There are some (including me) who also think that it might be intestinal TB as I am originally from India and often travel to India. Back in Nov 2011, I had some mild symptoms like bloating, gas, anemia, slight weight loss, and occasional fever. I never had diarrhea, vomiting, blood in stool, or abdominal pain. During a physical exam my GI doctor was able to feel a palpable mass in my lower right quadrant. He ordered a CT scan and colonoscopy. CT scan showed abnormal appearance of the Cecum and ascending colon and extensive thickening of the terminal ileum. There were no fistulas or abscess. During colonoscopy the doctor was not able to enter the terminal ileum due to structuring. He did a PPD skin test and Quantiferon gold blood test to rule out TB. Based on the findings my GI doctor put me on Mesalamine (Apriso) and Prednisone (30 mg).
Things didn’t improve much so he moved me on biologics (Humira). A week or two after starting Humira my condition worsened and I started feeling a lot of pain in the lower right quadrant. I was in so much pain that I could not even stand straight. Another CT scan done in the beginning of April showed that the inflammation had progressed since what it was back in Nov 2011. The GI doctor ordered vicodine and that along with a liquid/low residue diet has helped reducing the pain to some extent. I also got a small bowel series done this week which showed emergence of fistulas in the terminal ileum. There were no skip lesions or cobblestone type patterns identified in the barium X-ray.
My GI doctor recommended surgical consultation. He said that the Prednisone and Humira not doing much (making my symptoms worse) so the only way left is to resect the inflamed terminal ileum along with Cecum and part of ascending colon. I met the surgeon today and he is also recommending surgery as soon as possible. The surgeon has told me to stop Humira.
Long story short, my condition has changed so much in the last 4-5 months that it hurts. I was just fine before. I wish I had never started these dreadful meds.
Read more: http://www.crohnsforum.com/showthread.php?t=35422
So, what’s the point? Realize some drugs may work and some won’t because of our unique, internal anatomy and individual biochemistry. Once you realize that, and most doctors do, you’ll understand treating Crohn’s with drugs is about experimentation. Let me say that again: treating Crohn’s sufferers with drugs is about experimentation! Here’s an example.
Years ago, many GI doctors realized that using several drugs to treat Crohn’s is probably better than one. Here’s the study that confirms it.
Two-Drug Combo Twice as Effective for Crohn’s Disease Remission, Study Suggests
ScienceDaily (Apr. 14, 2010) — A study led by Mayo Clinic suggests remission from Crohn’s disease may be more likely if patients get biologic therapy combined with immune-suppressing drugs first instead of immune-suppressing drugs alone. The study, published in the April 15, 2010 issue of the New England Journal of Medicine, found treatment of moderate to severe Crohn’s disease with infliximab plus azathioprine allows more patients to achieve remission and mucosal healing than therapy with azathioprine alone.
“These study results are strong enough to change clinical practice,” says William Sandborn, M.D., gastroenterologist and vice chair of the Division of Gastroenterology & Hepatology, Mayo Clinic, Rochester. “They have certainly changed mine
Read more: http://www.sciencedaily.com/releases/2010/04/…
The only problem with combining multiple drugs is the potential side-effects!
When I was researching natural TNF blockers (health supplements that block TNF naturally) for my ebook Rapid Crohn’s Remission, I knew that some supplements would work better than others, but I also knew that combining them was the most effective way to induce remission as quickly as possible. That’s why I identified over 10 natural TNF blockers. All these TNF blockers are scientifically proven to reduce TNF, and a recent study with 3 supplements put all Crohn’s sufferers in remission in weeks – I cover this study in my ebook.