Hi Erin,
I hope you're doing better by now, and I hope your GI doc does what's best for you today.
Tex
Erin - Any Improvement With The Increased Dosage?
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Erin - Any Improvement With The Increased Dosage?
It is suspected that some of the hardest material known to science can be found in the skulls of GI specialists who insist that diet has nothing to do with the treatment of microscopic colitis.
Hi Tex!
Thanks for checking in with me! I felt much better once i started back on the 30mg dose over the weekend. I left a message with his nurse yesterday on how i am doing and waiting to hear back from him. he just got back from vacation yesterday so i am sure he was out straight and hope to hear from him today.
I am a bit nervous though that i am going to be one of those 'steroid dependant' cases and have issues tapering...keeping my fingers crossed that is not the case!! I am also planning on talking to him about the Entocort vs. the Asacol once he does add my maintenance drug to the regiman like you suggested, i agree with you on that one.
-Erin
Thanks for checking in with me! I felt much better once i started back on the 30mg dose over the weekend. I left a message with his nurse yesterday on how i am doing and waiting to hear back from him. he just got back from vacation yesterday so i am sure he was out straight and hope to hear from him today.
I am a bit nervous though that i am going to be one of those 'steroid dependant' cases and have issues tapering...keeping my fingers crossed that is not the case!! I am also planning on talking to him about the Entocort vs. the Asacol once he does add my maintenance drug to the regiman like you suggested, i agree with you on that one.
-Erin
Diagnosed with MC on 1/8/2008 after 7 months of flare. 2nd colonoscopy and new diagnosis of UC on 3/11/2008.
Erin,
It's good to hear that you're feeling better so soon. That's definitely a good sign.
If it's any help, here's a comparison of Entocort and Asacol in a clinical trial for Crohn's patients:
http://content.nejm.org/cgi/content/full/339/6/370
Note however, that this study was done as an initial treatment, rather than as a maintenance treatment. Still, it should follow that the comparison should be similar when the two meds are used for maintenance treatments.
Here's a report that shows the effectiveness of daily treatment using 6 mg, 9 mg, and 18 mg, (a double dose), of budesonide. IOW, Entocort can be safely used at double strength, if necessary, without significantly increasing the risk of side effects.
http://www.ncbi.nlm.nih.gov/pubmed/13680283
Like most clinical trials that have been published, this one is for Crohn's disease, of course. Note that the higher doses of budesonide are more effective when the inflammation involves the distal colon.
As I'm sure you're aware, UC is a "horse of a different color", and unlike Crohn's, UC affects only the colon, and sometimes only the distal end of the colon. When that's the case, the higher doses of orally-administered meds are sometimes necessary, in order to get enough of the active ingredient to the target area.
If you've looked at UC discussion boards, you've probably seen that many patients are happy with the results that they get from Asacol, (and some are not, of course). It's certainly possible that it may work for you, as a maintenance treatment, but the primary goal is to establish remission, and get away from the Prednisone ASAP. IMO, transitioning to Entocort may be the best way to do that, because it will allow you to safely use a corticosteroid for a long period of time, if necessary, without so many of the Draconian side effects that come with Prednisone, even if you should have to use as much as a double dose, in order to achieve/maintain remission. The transition has to be done carefully, though, because the effects of a corticosteroid overdose can be serious. One of our members went through that, because of a mistake by her doctor, and after going through a life-threatening scare, for about a week or so, she is now living with permanent blood pressure issues that she has to monitor closely.
The main point is, though, if it should turn out that you are indeed one of the many patients who are "steroid dependent", due to the inability to taper off Prednisone without losing remission, budesonide has been demonstrated to be quite effective in therapy to resolve dependence on conventional glucocorticosteroids, (such as Prednisone), specifically regarding patents with ulcerative colitis.
http://www.blackwell-synergy.com/doi/ab ... 97.00263.x
Remember that Prednisone is so effective because it's a systemic medication, and affects virtually every organ in the body, but this is precisely why dependence can become such a problem. Budesonide is not a systemic, (if I remember correctly, only about 10% of the active ingredient gets into the bloodstream), so a higher dose is sometimes required in order to obtain a satisfactory response when treating inflammation at the distal end of the colon.
Once you are able to get away from the Prednisone, and still maintain remission, then you can consider trying Asacol, or some other 5-ASA med, as a maintenance treatment. First, though, your colon needs to heal sufficiently that a maintenance med will work. Obviously, you're not close to that point yet. Many/most doctors don't seem to comprehend the importance of allowing sufficient time for the gut to heal before ending treatment, for patients with severe, or slow to resolve inflammation.
Good luck with dealing with your doctor, and thanks for the update.
Tex
It's good to hear that you're feeling better so soon. That's definitely a good sign.
If it's any help, here's a comparison of Entocort and Asacol in a clinical trial for Crohn's patients:
http://content.nejm.org/cgi/content/full/339/6/370
Note however, that this study was done as an initial treatment, rather than as a maintenance treatment. Still, it should follow that the comparison should be similar when the two meds are used for maintenance treatments.
Here's a report that shows the effectiveness of daily treatment using 6 mg, 9 mg, and 18 mg, (a double dose), of budesonide. IOW, Entocort can be safely used at double strength, if necessary, without significantly increasing the risk of side effects.
http://www.ncbi.nlm.nih.gov/pubmed/13680283
Like most clinical trials that have been published, this one is for Crohn's disease, of course. Note that the higher doses of budesonide are more effective when the inflammation involves the distal colon.
As I'm sure you're aware, UC is a "horse of a different color", and unlike Crohn's, UC affects only the colon, and sometimes only the distal end of the colon. When that's the case, the higher doses of orally-administered meds are sometimes necessary, in order to get enough of the active ingredient to the target area.
If you've looked at UC discussion boards, you've probably seen that many patients are happy with the results that they get from Asacol, (and some are not, of course). It's certainly possible that it may work for you, as a maintenance treatment, but the primary goal is to establish remission, and get away from the Prednisone ASAP. IMO, transitioning to Entocort may be the best way to do that, because it will allow you to safely use a corticosteroid for a long period of time, if necessary, without so many of the Draconian side effects that come with Prednisone, even if you should have to use as much as a double dose, in order to achieve/maintain remission. The transition has to be done carefully, though, because the effects of a corticosteroid overdose can be serious. One of our members went through that, because of a mistake by her doctor, and after going through a life-threatening scare, for about a week or so, she is now living with permanent blood pressure issues that she has to monitor closely.
The main point is, though, if it should turn out that you are indeed one of the many patients who are "steroid dependent", due to the inability to taper off Prednisone without losing remission, budesonide has been demonstrated to be quite effective in therapy to resolve dependence on conventional glucocorticosteroids, (such as Prednisone), specifically regarding patents with ulcerative colitis.
http://www.blackwell-synergy.com/doi/ab ... 97.00263.x
Remember that Prednisone is so effective because it's a systemic medication, and affects virtually every organ in the body, but this is precisely why dependence can become such a problem. Budesonide is not a systemic, (if I remember correctly, only about 10% of the active ingredient gets into the bloodstream), so a higher dose is sometimes required in order to obtain a satisfactory response when treating inflammation at the distal end of the colon.
Once you are able to get away from the Prednisone, and still maintain remission, then you can consider trying Asacol, or some other 5-ASA med, as a maintenance treatment. First, though, your colon needs to heal sufficiently that a maintenance med will work. Obviously, you're not close to that point yet. Many/most doctors don't seem to comprehend the importance of allowing sufficient time for the gut to heal before ending treatment, for patients with severe, or slow to resolve inflammation.
Good luck with dealing with your doctor, and thanks for the update.
Tex