I had ulcerative colitis and stuck with mesalimine as my primary treatment for years due to concerns about adverse effects. Starting in 2020 things got noticeably worse endoscopically so that I finally gave in to my GI doctor's advice to take stronger measures. I failed on Humira (no relief but developed neuropathy and the general view was that severe inflammation and/or Humira caused a stroke). Next I tried Entyvio and then Stelara. They gave some healing, but I could not maintain therapeutic levels, even with monthly doses. Finally I tried Rinvoq (concluding the risks of heart/stroke issues were outweighed by the potential benefits). Between Aug 2022 and Jan 2023 colonoscopy assessments went from severe UC/inflammation to mild - tho by then there had been a lot of scarring of my colon etc. And in the meantime precancerous polyps started convertinag to cancer by the time they could be removed, so that I recently had a colectomy.

My thoughts: (1) I felt that over the years the stronger medications have been over sold in that serious adverse effects are a real risk and I was surprised by the relatively low success rate for drugs like Humira. So it is difficult to find the right path. (2) The step therapy approach taken by insurance companies can be a real impediment. At the time I had to fail with a TNF blocker before I could try Entyvio, which my GI dr believed would have been a better choice, and there were some indications Entyvio was less likely to be effective following a failed TNF blocker. (3) But there has been a lot of progress in developing effective treatments which appears to be continuing. So there is hope.