Hi Joanne,
To put the PA's comments into context you have to realize that this is a standard line (explanation) used in the GI specialty and probably many other medical specialties. IOW, this is the program that they follow because they believe it is the best way to proceed (until proven otherwise).
Uceris is not like Entocort or generic budesonide, or prednisone. Entocort becomes activated in the ileum and colon. Up to roughly 20 % of the budesonide in Entocort can enter the blood stream because it activates in the ileum. This is so much better than prednisone because with prednisone there is no delayed activation, so a very high percentage can enter the bloodstream Uceris does not become activated until is is well into the colon so that none of it should enter the bloodstream to disrupt adrenal performance the way that other corticosteroids do.
Because of that, no tapering is required with Uceris because there should be no adrenal effects.
That said, the main reason why we (the members of this board) taper budesonide treatments is because when the drug treatment is ended, a rebound effect occurs that triggers increased mast call production and activation. This occurs because the primary mode by which corticosteroids suppress inflammation is by suppressing the production and activation of mast cells. So naturally when the drug is withdrawn, mast call numbers are going to rebuild. If the drug is stopped abruptly, the rebound can overshoot, resulting in much more mast cell activity than there was to begin with, and this can trigger an MC relapse. By tapering the withdrawal, this rebound effect is minimized.
We don't know if Uceris can cause this rebound effect if it is stopped too abruptly, because so far, no one has reported a relapse after stopping Uceris. But that may be because most (not all) taper their dosage. We just don't have enough usage data to know for sure.
I have a hunch that tapering with Uceris is not anywhere near as important as tapering with Entocort or generic budesonide, and it may not be necessary at all. So yes, I generally agree with your Doc's PA. The tapering procedure with Entocort is much more important for those who have histamine/mast cell issues than it is for those who do not have those issues.
I hope that this is helpful.
Tex