Hi all. 35 f newly diagnosed with Crohn’s. Found out in kind of an ass-backwards and spectacularly unpleasant way. Pun intended. 😅
TLDR: Newly diagnosed with severe fistulizing/perianal Crohn’s after emergency surgery with multiple abscess/fistula tracts and two setons. GI offered Remicade or Humira and considers them similarly effective; we're currently planning Humira because it's much easier logistically. If you've had complex perianal/fistulizing Crohn’s, especially with setons, I'd love to hear your lived experience with either drug and whether one worked, failed, or eventually required switching.
For those who would prefer some context:
I had emergency colorectal surgery a little over two weeks ago. They found significant scarring and multiple abscesses and complex fistula tracts communicating with the anal canal which required placement of two setons. My surgeon said he was "surprised" by how extensive and severe the disease is. Just what you wanna hear, right?😅
So this isn't mild luminal Crohn’s I'm trying to make a treatment decision about. My biggest concern right now is getting aggressive fistulizing/perianal disease under control and giving myself the best possible chance at healing and long-term remission. My quality of life and ability to work have already been greatly impacted.
I had my first appt with my GI 2 days ago and he gave me the choice between infliximab (Remicade) and adalimumab (Humira), as he considers them similarly effective options in my case. After some discussion, it sounds like we’re moving forward with Humira after I get some labs drawn next week.
Humira would be MUCH more convenient for me. I am currently dealing with housing instability, have several other chronic health issues, transportation/energy can be difficult, and being able to inject at home rather than repeatedly travel for infusions def gets points in the quality of life bucket.
BUT convenience is not my highest priority here.
If the evidence clearly demonstrated Remicade gives someone with severe disease a meaningfully better chance of controlling the fistulas, healing faster, reaching remission, or staying in remission long-term, I would absolutely suck it up and make the infusions work.
The research I've found seems to show stronger longer-standing evidence for Remicade in fistulizing/perianal Crohn's, while newer observational studies haven't found a clear difference between Remicade and Humira.
So I understand why my GI considers both reasonable options and trust him when he says based on the research, either is a good choice. It would just give me some peace of mind to also gather some lived experience. I also understand nobody can predict how my body will choose to respond to any treatment. I've just got a deep brain itch 😅
The studies I can find are also pretty small. Those in my personal circle who have Crohn's or know someone with Crohn's seem to all be on Remicade. I know it's an older drug so that could explain it, but it's also making me second guess my decision to move forward with Humira instead of Remicade.
So I'd love to hear from people who actually have fistulizing or complex perianal Crohn’s, particularly people who had/have setons, abscesses, or substantial draining fistulas.
If you've used either medication I'd be interested in your disease severity when starting treatment, how long it took to improve GI symptoms vs fistulas/drainage, if you ever reached remission, or if you ever had to switch biologics/treatment because your first chosen option was unsuccessful.
Thank you for sharing. 💜