Should I Continue Taking Celebrex After 25 Days with No Improvement?

I have been taking Silhouette for 25 days with no results. Should I continue taking Silhouette?

Hello Dr.
Gao, I am a patient with ankylosing spondylitis.
I am currently undergoing treatment with 2 tablets of Celebrex daily, and my inflammation markers are within the normal range.
The only remaining symptoms are morning stiffness lasting about 1 hour and very mild back pain, which only occurs when bending significantly, and it does not affect my daily life or exercise.
Recently, I have been trying to add 2 tablets of Humira daily (1 in the morning and 1 in the evening), and I have been taking it for 25 consecutive days, but I feel that there has been no improvement in my morning stiffness or back pain.
The leaflet for Humira mentions that if there is no effect after 6 weeks (42 days), it is unlikely to be effective.
I would like to ask you, Dr.
Gao, since I have already taken it for 25 days with no improvement, should I continue taking it until 42 days? Can I expect a sudden improvement in the next 10 days? Thank you, doctor.

Zheng, 20~29 year old female. Ask Date: 2023/09/11

Dr. Gao Jiankai reply Internal Medicine

Hello, thank you for your question.
I recommend that you take the medication for a full 28 days.
If you still do not see any improvement, please consult your physician for a medication adjustment.
This approach not only allows for a longer evaluation period of the anti-inflammatory and analgesic effects, but also ensures that if you need to apply for targeted therapy in the future, the evaluation period for each type of anti-inflammatory and analgesic medication will be one month, which will minimize any impact on future medication applications.
This is from the Allergy, Immunology, and Rheumatology Department of Changhua Hospital, Ministry of Health and Welfare.
We care about you.

Reply Date: 2023/09/11

More Info

It sounds like you are dealing with a challenging situation regarding your treatment for ankylosing spondylitis (AS). You have been taking Celebrex (celecoxib) and have recently added Simponi (golimumab) to your regimen. Given that you have not noticed any improvement after 25 days of taking Simponi, it’s understandable that you might be feeling frustrated and uncertain about whether to continue.

First, it’s important to recognize that both Celebrex and Simponi are used to manage symptoms of AS, but they work in different ways. Celebrex is a non-steroidal anti-inflammatory drug (NSAID) that helps reduce inflammation and pain, while Simponi is a biologic medication that targets specific pathways in the immune system to reduce inflammation. The response to these medications can vary significantly from person to person.

Regarding your question about whether to continue taking Simponi until the 42-day mark, it is generally advisable to follow the guidance provided in the medication's prescribing information. The recommendation to continue for 6 weeks before assessing efficacy is based on clinical studies that show it may take time for the medication to reach its full effect. However, if you are experiencing no improvement at all, it is crucial to communicate this to your healthcare provider. They may want to evaluate your treatment plan and consider alternative options or adjustments.

It is also worth noting that while some patients may experience a sudden improvement in symptoms, it is not guaranteed. The timeline for response can vary widely, and some individuals may take longer to notice benefits. Additionally, the presence of morning stiffness and mild back pain, even if they do not significantly impact your daily life, indicates that inflammation is still present and may require further management.

In terms of your overall treatment strategy, it’s essential to maintain open communication with your healthcare provider. They can help assess your current symptoms, review your treatment regimen, and determine if any changes are necessary. This may include adjusting the dosage of your current medications, switching to a different biologic, or adding other therapies such as physical therapy or exercise programs tailored to your condition.

Furthermore, lifestyle modifications can also play a significant role in managing AS symptoms. Regular physical activity, stretching exercises, and maintaining good posture can help alleviate stiffness and improve overall function. Some patients find that heat therapy, such as warm baths or heating pads, can provide temporary relief from stiffness and pain.

In summary, while it may be beneficial to continue taking Simponi for the full 42 days as per the prescribing information, it is crucial to keep your healthcare provider informed about your lack of improvement. They can provide personalized advice and may suggest alternative treatment options if necessary. Remember, managing ankylosing spondylitis often requires a multifaceted approach, including medication, physical therapy, and lifestyle changes, to achieve the best outcomes.

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