Questions Answered By Expert
Karlee Ausk, MD
associate director of the Swedish IBD Center
A: Remicade is available in Japan. It would require careful planning, but travel abroad can be accomplished successfully. Your son would need to quickly establish care with a GI provider in Japan who would be able to provide the Remicade while he is abroad. His care provider here may be able to help find a hospital or provider that would be appropriate. hide answer
A: Diarrhea due to chemotherapy can be challenging to manage, especially when you also have Crohn’s disease. Your plan of Immodium and cholestyramine sounds like a good next step. There is a stronger medication that can help to slow diarrhea, but it is a narcotic medication. If the maximum doses of Immodium and cholestyramine are not effective, you would need to talk to your care providers about the downsides of other options and whether it would be appropriate to try a stronger medication during this time. hide answer
A: It sounds like you are really struggling to get your Crohn’s disease under control. I would recommend that you meet with your doctor to review your response to the medications and any side effects that you are having. I can not say whether the treatments should be stopped without seeing you, but your care provider should be able to provide that guidance. I try to give Remicade around 12 weeks to see if it is effective. I then use symptoms and other tests (sometimes labs, imaging, or endoscopy depending on the patient) to help make this decision. hide answer
A: Ustekinumab is a medication currently used for psoriasis that works by blocking inflammatory proteins called interleukins. There are early studies showing promise in the treatment of Crohn’s disease. Because it does not block TNF, it offers a new mechanism for treating Crohn’s and may be a good option for patients in whom Remicade and Humira have had no effect. It is not yet FDA approved for Crohn’s disease. On an individual basis, it might be the best next treatment for certain patients. Your care provider would need to help you make this decision and see whether insurance coverage would be possible for your individual case. hide answer
A: In patients newly diagnosed with moderate to severe Crohn’s disease, combination therapy with Remicade plus immunomodulator has about 56% chance of steroid free remission at 26 weeks and Remicade alone has about 45% likelihood of steroid-free remission at 26 weeks. This study is not looking at patients who stopped therapy. Stopping therapy does increase the chance of anti-drug antibodies and loss of effectiveness in the future. I would recommend an honest discussion with your care provider before stopping any therapy. hide answer