Infliximab (Remicade) or Adalimumab (Humira)?

May 6, 2016 5:49 AM

I was diagnosed with Crohn's colitis about five years ago. I've been on Asacol and Mercaptopurine for most of that time, with a few courses of prednisone for flares. There's now a prospect of my moving on to either Infliximab (Remicade) or Adalimumab (Humira); has anyone got experiences which shed light on the question of which I should choose? I understand that the former requires hospital visits for infusion, while the latter can be done by subcutaneous injection at home. I'm not needle phobic. This is the UK NHS so cost is not a factor.
posted by Segundus to Health & Fitness (12 answers total)

i don't have crohn's, but subcutaneous injections are a lot easier if you have an auto-injector of some kind (basically a spring loaded device that does the injection for you). in my experience, with that, it's a chore but perfectly doable. without it, well, i am not needle phobic, but it's kinda squicky (but still livable). i think i'd choose it over having to visit a hospital regularly (unless it was once a month or less v daily stabs).
posted by andrewcooke at 5:59 AM on May 6, 2016

My husband has been on Humira now for a few years and it has been completely life changing. Our whole family is so thankful that his body has reacted positively to this medicine. He does not restrict his diet at all now and has had no major flair-ups since the start of this medication. He does SC injections biweekly; they aren't comfortable, but it has just become a part of regular life. Kids know not to attack daddy while he's injecting, takes less than 5 mins. Let me know if I can answer any more questions for you. Best of luck with your decision making.
posted by rabidsegue at 6:01 AM on May 6, 2016

I've been on Humira for 5 years. It has been very effective for me, and I find self-injecting very easy. I think you can get it in needle form, but most folks use the pens, which are pretty foolproof. For me, the injection is mildly uncomfortable (like a bee sting).

I have a friend who is on Remicade, and it is working well for her. I remember my doctor saying that she had several patients who preferred it because they travel a lot for work and it is easier for them to block off days for infusions than to carry injector pens around with them. Humira does need to be refrigerated, so it can be a pain to travel with.
posted by hydropsyche at 6:33 AM on May 6, 2016

I took Humira for years for arthritis, and I had no problems with it other than the fact that after a few years it stopped being effective.

I preferred the needles to the self injectors because I bruise easily, and that meant that I always had a bunch of SNAFU whenever I got a new prescription because everybody along the line would assume that I wanted the self-injectors. I'd call the doctor's office, the insurance company, and the specialty mail order pharmacy, and then have to call all of them all over again when the self-injectors would be delivered despite all the previous phone calls. And all this after stressing what I wanted to the doctor at my regular appointments and him reassuring me it would be no problem. So I would generally have a few months without medication between prescriptions cycles.
posted by The Underpants Monster at 8:01 AM on May 6, 2016

It's a crapshoot. Some people respond to one but not the other, many people respond to both, and some people respond to neither. There are no well validated ways to predict how a particular Crohn's patient will respond to a particular biologic. Because Remicade is based on a mouse protein it's more likely to cause adverse reactions, and is usually co-administered with an antihistamine or steroid, and in my experience in the US is being newly prescribed less often nowadays.

Some people report that Humira injections are especially painful, but some people don't, and by and large almost everyone who has a good response sticks with it even if they find the injection to be painful.

Go with your gut (pun intended) and if you don't feel inclined in either direction, just ask your doctor to decide.
posted by telegraph at 8:03 AM on May 6, 2016

I am on infusions of Remicade, after finding out that Entyvio (newer med) did not work for my ulcerative colitis. I have had no side effects, and have been able to stop taking Prednisone after about a year of being on them. Unfortunately, it may just have to be a trial-and-error thing for you (like me finding out that Entyvio didn't help). The infusions are two hours in length, but have them on a Friday afternoon, so I can just go home afterward.

My GI doc has me on some folic acid and methotrexate (injection I do myself) to combat any side effects from the Remicade.
posted by kuanes at 8:14 AM on May 6, 2016

Forgot: the infusion schedule was 0 day, two weeks after 0 day, 6 weeks from two week day, and then every 8 weeks. My GI doc did say that the frequency could be adjusted by 1-2 weeks if I found my symptoms flaring after 6-7 weeks (has not happened yet).
posted by kuanes at 8:17 AM on May 6, 2016

I use infliximab (I've just been changed to Remsima from Remicade, but that's for price reasons). I totally find things easier getting the infusion than having to inject myself. My hospital's got comfy chairs and a nice view of the hills and friendly staff and I get pleasantly spaced out on the antihistamine, so I pretty much look forward to it. I can't imagine the hospitals in London are any different, apart from lacking the view of the Cotswolds.

I'm happier not injecting myself, or indeed trusting myself to do it at the right time, but I wouldn't have any other particular feedback about it.

NICE guidance is that they have to go with the cheapest suitable drug, so I don't know whether you've been given a choice or not. Infliximab works out slightly cheaper, depending on how much you weigh, although the current BNF doesn't seem to have prices for Remsima, which I think is lots cheaper than Remicade.
posted by ambrosen at 10:28 AM on May 6, 2016

if it's any help, i've travelled fairly extensively with drugs that have to be kept cool (below 25C, like humira). it's a nuisance, because it's one more thing to worry about, and it's difficult to find any online guidance saying it will be ok. but in practice it has never been a problem (i have never been refused boarding and recently the usa changed their regulations to explicitly allow frozen blocks in hand luggage).

(tbh i think i'd swap my alternate days injection for an 8-weekly visit to the local clinic if i had the chance. that sounds pretty sweet, if everything else was equal.)
posted by andrewcooke at 10:48 AM on May 6, 2016

I've been on both Humira and Remicade (after a few other things including 6MP and Pentasa didn't really work - I actually didn't tolerate the 6MP at all). As others have said, you may, ultimately not have a choice. Humira didn't seem to have any effect on my Crohn's flares, but Remicade has been great for a few years now. I, personally, prefer the infusion center visits every 6 weeks to injecting myself, but that's just me. Anecdotally (and I think someone else alluded to this above), it does seem like docs usually start someone on Humira first to try that vs Remicade. I haven't had any particular side effect from either of them though. Good luck to you in figuring it out! Crohn's sucks!
posted by stefnet at 1:47 PM on May 6, 2016

I've been on Humira for ~8 years (for Crohn's) and found that the prefilled needles were a lot better for me. The initial multiple pen loading dose was really not fun - that's what made me try the needles. You can control how quickly you inject the medication that way -- which really helps it not sting as much (along with taking it out of the fridge ~30 minutes before taking it). It's definitely weird to inject yourself but you do get used to it.

It is a bit annoying when traveling but can be dealt with.

I tried a few doses of Remicade with no response (before Humira). It was also pretty inconvenient for me - particularly since I'd lose a lot of my day because Benadryl knocks me out.

Good luck! It's such a pain trying to find meds that work for you =\
posted by majikstreet at 10:28 PM on May 6, 2016

Response by poster: I'm really grateful for all these answers (and for mail correspondence); they are very helpful and have moved my thinking on a lot (by the way, I was given an explicit assurance that the choice was up to me, not that you can always rely on one doctor's assurances if another takes over).

I couldn't pick out a 'best answer', but you are all most excellent.
posted by Segundus at 5:18 AM on May 7, 2016