What is the minimum number of drug(s) a member is required to try prior to receiving approval for remicade?
Answers
The term "maintenance therapy" refers to the various kinds of treatment (usually medical) given to patients to enable them to maintain their health in a disease-free, or limited-disease, state. If you have been diagnosed with Crohn's disease or ulcerative colitis, the first goal of treatment is for you to get better (a stage in the illness known as going into "remission"). The next challenge is to keep you in remission. The treatments used for this second step are referred to as "maintenance therapies."
Why is Maintenance Therapy Needed in IBD?
Both Crohn's disease and ulcerative colitis are chronic inflammatory diseases. Although symptoms may disappear, they tend to recur over time. Many people with IBD respond well to medications when they have a flare-up. Unfortunately, they are at risk for future attacks unless they continue to take certain medications that will keep them in remission. Because these medications are needed over a prolonged period, they must be both effective and safe.
Antibiotics
Antibiotics are effective as chronic (long-term) therapy in some people with IBD, particularly Crohn's disease patients who have such problems as fistulas (abnormal channels that connect loops of intestine to the skin) or recurrent abscesses (pockets of pus) near their anus. The most commonly prescribed antibiotics are metronidazole (Flagyl®) and ciprofloxacin (Cipro®), although there are many others that may be effective in certain individuals.
Patients whose active disease is successfully treated with antibiotics may be kept on these medications as maintenance therapy if the agents remain effective. Side effects can be particularly troublesome with metronidazole, including tingling of the hands and feet that may persist even after the drug is discontinued. Alcohol intake and exposure to the sun are discouraged, and in most cases these agents are not continued during pregnancy.
Corticosteroids (Steroids)
Steroids (e.g., prednisone, prednisolone, budesonide) are often used in the acute treatment phase when the 5-ASA drugs are not working. Steroids work quickly and effectively in most cases. However, despite their benefit in treating acute illness, steroids are not effective in preventing flare-ups and thus are rarely used as a maintenance medication in either Crohn's disease or ulcerative colitis. Steroids also have many potentially serious side effects—such as elevated blood sugar, high blood pressure, cataracts, osteoporosis (even leading to bone fractures), among others. The risk of adverse effects increases with the duration of the treatment. Thus, steroids should only be used to control the disease. They should then be phased out gradually, while another agent is used to maintain remission.
Strategies to eliminate steroids include increasing the dose of the 5-ASA agents, adding a 5-ASA enema or suppository if the IBD is located in the rectum or distal (lower) colon, or introducing either an antibiotic or one of the newer medications described below. Some patients require surgery if they still cannot effectively reduce or eliminate steroids from their medical regimen.