u/Brumbertton

I’m currently taking Pentasa 4g granules daily plus Salofalk enemas at night, but it’s not quite getting me into full remission.

My recent sigmoidoscopy showed improvement from Mayo 2 to Mayo 1 inflammation over a 40–70cm area. The inflammation is mild and the rectum was completely normal. I also don’t really have major symptoms right now. No real bleeding, no urgency, only mild occasional sensations on the left side. But my calprotectin is still around 700.

So obviously something still needs to improve. Personally I’m not convinced yet that I need Azathioprine or biologics because the disease activity seems relatively mild.

I’m wondering if anyone here noticed a difference after switching oral mesalamine brands or formulations. For example changing from Pentasa to something more pH dependent like Mezavant or Asacol that targets the colon more directly instead of releasing throughout the small intestine.

Did anyone improve just from changing the type of oral mesalamine?

Has anyone gone straight to a biological, specifically Entyvio, after failing mesalamine?

I just finished a 10-week Cortiment 9mg course but my calprotectin is still at 500. No real symptoms and I feel fine, but my doctor is recommending switching to azathioprine.

I've been doing my own research though and Entyvio seems like a much better option with a cleaner side effect profile. Wondering if anyone has experience pushing back on the step therapy approach and going straight to a biological?