My son is allergic to remicade. He has been on humira and methotextrate for 18 months. He had his takedown 2 years go. Because he has been doing well and we were measuring humira levels, we were able to space out the humira to monthly shots. But this time we measured the level and the humira level is down to 3 and he has developed antibodies over 2. The dr's response is to increase humira or to switch to a new medicine. His labs are fine. His cal protection shows no inflammation, even with the reduced humira on board. And he feels fine and follows a very "clean" diet, close to paleo. Is it possible he just does not need the medicine? Is there some significance to the fact that he built antibodies now...i.e. is that a sign he has disease, or just that he cannot tolerate the medicine?
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Antibody buildup generally means the med is having less therapeutic effect, because that's what antibodies do: tell the body to fight off the thing/increase resistance to whatever it is they're against.
"The antibody binds to specific antigens. This signals the other cells of the immune system to get rid of the invading microbes. The strength of binding between the antibody and an antigen at a single binding site is known as the antibody's affinity for the antigen."
In my days of sulfasalazine and steroids, we were constantly weaning meds, trying to get me med free. Never worked.
My daughter's GI feels she'll be on Humira til... well, she isn't, meaning til she "isn't" controlled. Guess we will cross that bridge when it's in our face.
Thank you. I understand the med is having less effect because the antibodies are interfering with the medicine. But does antibody build up signify more disease activity or is it just a reaction that happens not necessarily tied to the disease? Thanks for any more insight.
No, it is not an indication of more disease activity. The antibodies are specific to the drug. It means that you need higher doses for the same effect, and it may mean that more and more antibodies will form in response. Essentially, you will need to switch to something else. I didn't even have antibody titers done, but knew it was time to move on when symptoms crept back. I've gone from Enbrel to Humira to Simponi to Cimzia.
But that does not mean that there cannot be new disease activity because of the loss of effectiveness.
There is always something new to try and they seem to get better with each new generation of drug.
Jan, could you tell me what you like about Cimsiz versus Simponi?
Also, we had thought my son ( now age 14) would not need the anti TNF drugs post having his colon removed. What do you think about taking him off all meds but monitoring him closely - is there danger in the fact that he could get inflammation/flare? we would be monitoring him so would know to get him back on drugs if he deteriorated....
The only thing I like better about Cimzia is that it is working when Simponi was losing effectiveness.
I can't tell you what the best treatment path is for your aon. We all hope to avoid drug treatment post colectomy, but it does not always work out that way.