My Experience Transitioning from a Biologic to an Oral Medication

Can you switch from a biologic to an oral medication? Although this typically isn’t recommended, my doctor and I decided to try this transition in 2016. Keep reading to find out why we made this decision and how it worked out for me.

Before Switching Meds, I Had a Colonoscopy

The first step in this transition was for me to get a colonoscopy. At this time, I had been on Remicade for just over a year, and I was feeling absolutely amazing. But we needed to check the plumbing to make sure my colon was actually as healthy as I felt.

So in December 2015, I had my second-ever colonoscopy. The results were exactly what we were hoping for! The walls of my intestine were smooth and pink instead of a burning, inflamed red.

Not your typical before and after shot, but here are my transformation photos from 2014 vs 2015:

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Weighing the Pros and Cons of Switching to an Oral Medication

A part of me was definitely hesitant to drop Remicade—the only drug to have put me in remission—and take a chance on Sulfasalazine. After all, no pill I’d tried in the past worked for longer than a few months.

But, on the other hand, it would be great to leave behind the harsh side effects of Remicade and not need to get infusions every eight weeks.

Why My Doctor Believed I’d Do Well on Sulfasalazine

Ultimately my doctor believed I’d do well on the pill because, at this time, my disease was under control. When I had tried other pills in the past, my ulcerative colitis was active and widespread. I had never tried a pill while in remission.

As much as I loved and trusted Remicade, if it was possible to live life with daily pills rather than pumping meds straight into my bloodstream for the rest of my life, I’d prefer that.

Why I Personally Wanted to Transition from Remicade to Sulfasalazine

Around this time, boyfriend Tyler and I were getting more serious and discussing the possibility of getting married in the summer of 2017. I told my doctor about this when we were talking about timelines, and she said that we’d have just enough time to place me on this pill and monitor it for about a year, and still have a little buffer time before the wedding.

With these timeframes aligning, I decided to break up with Remicade and take a chance on Sulfasalazine.

What is Sulfasalazine?

Sulfasalazine is an aminosalicylate (5-ASA) drug. 5-ASAs contain acid and reduce the inflammation in the intestine’s lining. Sulfasalazine usually maintains remission in individuals who have only mild to moderate ulcerative colitis (or mild Crohn’s).

This could be a reason why pills didn’t work for me when I was first diagnosed—because mine was classified as moderate to severe.

Sulfasalazine must be taken with folic acid pills each day because the drug can negatively affect the absorption of folate.

One Thing I Disliked About Sulfasalazine

Sulfasalazine wasn’t my favorite pill because it’s literally shaped like a penny—circular and flat.

I don’t know who came up with that design, but it’s not optimal for swallowing. Many times, it became lodged in my esophagus. I got used to keeping bread, crackers, and water on hand to push it down my throat.

Eventually, I learned how to situate the pill in my mouth so it would go down length-wise every time.

Side note: Its copper color also made my saliva yellow, which would always catch me off guard at first when brushing my teeth.

Strange pill.

My Immediate Reaction to the Switch

It was a cautious transition from Remicade to Sulfasalazine. Kind of like walking on eggshells.

I tried to be in tune with every twinge and minor ache in my body, ready to call up my doctor and go back on Remicade if I thought I was headed in the direction of a flare.

But that didn’t happen. Sulfasalazine was working!

Monitoring Through Stool Testing

Of course, my doctor didn’t simply put me on the drug and say, “Good luck, I hope it works!” She kept a watchful eye on me the entire time through regular stool testing.

Every so often, I’d go pick up an at-home stool testing kit and my doctor would call me with the results. It’s a great preventative method because it can warn you if you’re headed down the path of a flare; your stool knows before you do if a flare is on the horizon!

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They also give me this neat little stool kit:

For this collection method, you go to the toilet like normal (without the hat), use the brushes to swirl around in the water, and place those drops onto the blue sample square.

After all these samples are collected, I delivered them to the lab. Not a few days would go by before I’d get a call from my doctor telling me the results. My doctor loved this system because it’s quick and easy to do regularly, as opposed to a colonoscopy.

Achieving Remission on Sulfasalazine (For a Little While)

From July 2016 through April 2017, Sulfasalazine and its folic acid sidekick created a wonderful remission period for me.

In April 2016, I graduated college with a bachelor’s degree in Business Management, so it was amazing being in remission during the graduation ceremony, throughout my job hunt, and starting my first “real” job at a staffing agency.

Tyler proposed in September 2016 beside a gushing waterfall after a hike, and Sulfasalazine allowed us to buckle down and plan the wedding during this time of remission.

Everything was lining up.

Life was back on track.

Running to the bathroom was no longer number one on my to-do list.

Tyler and I actually had time to hang out.

It Did Not Put Me in Long-Term Remission

One month before our wedding, I flared. My doctor and I had to act quickly to manage my symptoms before the wedding, I wrote a follow-up blog post about that experience that shares the food and medication that helped me make it through this flare.

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