Steroids vs Remicade: What's the difference?
(e.g., prednisone, prednisolone, budesonide) are similar to the steroids that our body naturally makes in response to stress or illness.Steroids
suppress the immune response and decrease inflammation, which is why they have been used in many inflammatory conditions, including Crohn's
and ulcerative colitis
work quickly and effectively in most cases. However, despite their benefit in treating acute illness, steroids are not effective in preventing flare-ups and thus are rarely used as a maintenance medication in either Crohn's disease
or ulcerative colitis
. Steroids also have a number of undesirable and dangerous effects. The risk of adverse effects increases with the duration of the treatment. Thus, steroids should only be used to control the disease. They should then be phased out gradually, while another agent is used to maintain remission.
Side effects include:
- Elevated blood sugar
- High blood pressure
- Easy bleeding
- Swelling of the face and legs
- Increased risk for many types of infections
- Mood changes
- Blurry vision (cataracts)
- Changes in appetite
There are three anti-TNF medicines used to treat Crohn's disease and ulcerative colitis. Infliximab (Remicade®)
was the first anti-TNF licensed for Crohn's disease, followed byadalimumab (Humira®)
, and certolizumab pegol (Cimzia®).
suppress the immune system by blocking a very specific agent called tumor necrosis factor (TNF). There are many chemicals in your body that cause and regulate inflammation. TNF appears to be very important in inflammatory bowel disease. While anti-TNF medications are not effective for every individual, many patients benefit from this class of medication.
The use of Remicade has revolutionized the care of IBD. It has shown to not only reduce the symptoms of IBD, but also results in healing of inflamed intestine. It may take up to 8 weeks after starting the drug to notice an improvement in symptoms, though many experience more immediate improvement.
Intolerance and attenuated response to Remicade
The use of Remicade is very well tolerated in the majority of patients but in a small subset of patients may lead to the production of antibodies (termed "antibodies to infliximab"-ATI). The production of these antibodies has been associated with the development of both acute and delayed infusion reactions, although even in patients who develop ATIs, these reactions are relatively uncommon. Nonetheless, these reactions may occasionally be severe enough to lead to intolerance to Remicade. Another group of patients, after initially having excellent responses to Remicade, experience an attenuated response or loss of response over time.
One of the major risks of using Remicade is the small but significant risk of serious opportunistic infection (e.g., tuberculosis). Opportunistic infection is defined as a usually serious and progressive infection by an organism that, under normal circumstances, possesses little or no pathologic capabilities.
Anti-TNFs including Remicade generally increase the chance of some cancers (increased risk of lymphoma). However, the possible risks of these medications are very often far outweighed by the benefits.
What was your experience on Remicade, and how long did it keep you in remission?
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