Update to previous two of my posts about flareup and adalimumab.
I have been admitted to hospital. Not really because I’m getting worse. It’s because I’m not improving enough. So at this point I’m about 5 weeks on prednisolone and 3 last weeks on highest dose. Also I have received initial dose of adalimumab (4x 40mg).
It has improved slightly, but not to any point close to remission. And taking under consideration how strong treatment I’m on, which exhaust maximum treatment options as outpatient I needed to be admitted to bring this under control. Also, high dose of prednisolone was already extended above accepted timing.
I have improved with majority symptoms, but unfortunately I haven’t stopped loosing blood. Amounts vary from little to a lot. Its obviously the most serious symptom and it’s affecting whole body and indicate there is still severe inflamation in bowel, even overall i feel much better. Common sens suggest I just can’t sit and watching how I’m loosing more and more blood. As I haven’t responded to oral prednisolone the obvious course of action was to give me intravenous hydrocortisone instead. But this require me to stay in hospital. I’m guessing they also want to give me some fluids to fed me up and bring levels of iron and other micros to normal levels.
Current treatment options they consider are:
- Intravenous hydrocortisone and keeping me on adalimumab, potentially weekly not 2-weekly
- Rescue dose of infliximab, scrapping adalimumab. As I have been previously responding to it well, but levels of antibodies against infliximab I potentially developed need to be confirmed.
- Cyclosporine
- Surgery
How it may escalate mainly depends on how I respond now to intravenous hydrocortisone. As I haven’t responded to prednisolone, there is high chance I’m something described as steroid refractory. It all doesn’t mean I haven’t responded to adalimumab. How I understeand it, I need strong kick to induct remission so adalimumab can maintain it.
I’ll keep you posted.
Stay healthy, Vic
