Azathioprine

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crohns_disease

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Jul 6, 2014
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How long does azathioprine take to get to remission? Currently on humira 40mg every other week but still have symptoms. Been on humira for 3 months +.
Thanks
 
I've been told by the doctor it could take 3 months+ to work. I'm now going onto remicade because azathioprine didn't work on its own.

Everyone's different so its hard to say. Keep your doctor posted. Meds may need adjusting.
 
Crohns_disease welcome to the forum.

We started Aza a couple of months ago now and found the 1st bit of relief at the 5 week mark for my daughter. She has tried a combo of almost everything else so we weren't so hopeful for this. She isn't at the 'normal' range yet, but much better than before down to 6-8x a day with a little less urgency. I had her tapered down to 15 mg of prednisone & she can't go better than that without declining fast.

What other meds are you on? If you are doing Aza with something like prednisone it will help you get to the point where it will kick in. Most all of the meds except Remicade can take up to 6 months to find out if it isn't working.
 
The other medicine taking is 40mg Humira every other week - been taking that since April. Started azathioprine a few days away and hoping for it to work. Any ideas on how to maximise the speed at which the azathioprine actually has an effect?
Thanks
 
Azathioprine is generally thought to take 2 to 4 months to kick in. It works by programming certain kinds of white cells to die off early. So you have to wait for the new cells that have been changed to start to die off which takes a while.

Alternative to AZA is Methotrexate which typically has a slightly faster time frame - maybe 3 weeks to 6 weeks. MTX is administered by once a week injection.

Has your doctor tried increasing the frequency of your Humira to once a week? Or increasing the dose to two shots per time? Those would typically be the first response if you have lost response or haven't achieved remission.
 
The dose has not been moved to one shot every week - do you think that the humira shots would work by themselves if the dose was increased? Just asking because I'm not a big fan of taking azathioprine
 
There is good research supporting the use of combination meds like Humira+Imuran or Humira+Methotrexate. Humira can work alone too but if your doc already has you on the combo it is unlikely he would drop one unless results prove a reason to. Time is the only thing that will tell if it will work. All you can do it keep yourself as healthy as you can eating the right foods for you. I haven't found a quicker way to make meds kick in. I have definitely tried!
 
Did you ever get a response to the Humira?

Whether to increase the frequency/dose of Humira or add AZA is a clinical decision that only your doctor can make. Obviously he feels the combo is the right way to go. I was just asking because manipulating the frequency/dose of humira would be the only other choice and I was wondering if that had already been tried.

There is no way to increase the speed of AZA effects.

Are you getting regular labs done? With AZA you would typically have labs done every 2 weeks for while then once a month and then once every 3 months.
 
Been on the humira for 3 months and felt okay within the first month but ever since then I haven't really felt well.
Just started the aza recently so haven't had any labs done yet - what would they normally be looking for in the labs?
 
Patricia, I have never heard of going 3 months between blood work on Aza. Is this your regimen? When we were on Remicade it was at the time of infusion and once in between (until the infusions became every month then only done at infusion), methotrexate was every other week then went to every other month (as did Humira because she was on them both at the same time). Imuran is every month. Doc wanted it every 2 weeks and we balked as I thought it was overload. Her blood orders on Imuran is for the next 6 months. How long were/are you on Aza that you go every 3 months?
 
SupportiveMom - My daughter started Imuran a month ago and we were told she would have weekly blood work for awhile, then every two weeks and then every month and finally every three months!
The weekly blood work is definitely a pain but I believe they're just watching her counts (WBC, RBC, platelets etc.) very carefully to make sure Imuran isn't suppressing them.
 
Every 3 months? On a kid? That makes it hard to catch a change with that much of a gap. I asked around to a few adults I know on it & they go monthly. One has been on it for 2 years. Maybe the blood work is overkill but id rather err on the side of caution. Do you have a choice to go every month or 3 months? Since diagnosis almost 2 years ago we have been getting blood work mostly every month for one reason or another. Out of all the drugs she has taken Aza scares me most for some odd reason.
 
With all of M's specialists, I find it hard to believe there will ever be a time when she's having blood work every 3 months (especially since she usually has blood work done at Remicade infusions which are every 4 weeks)! But that's the schedule her GI mentioned. Right now we're still doing it weekly, so I hadn't even really thought that far ahead.

Aza scares me too, more than the other drugs. I think it may be helping though!

I hope your daughter is doing better!
 
My daughter a bit older at 18 years. She is now out to 2-3 months on aza but it has taken us 2 years to get to this point.
 
My doctor wants to put me on azathioprine I'm on predisone at the moment 30mgs a day tapering 5 Mgs every 2 weeks I see her in September I'm a little worried about the side effects I was diagnosed with Crohn's on the 3 July so I'm a newbie at this
 
Maya, doing a holding pattern on D. She is better than she has ever been, we are on the longest stretch away from the hospital (3+ months!) Since diagnosis almost 2 yrs ago. With that she is still going 6-8x a day with pain. No diarrhea, no blood so we are grateful to be better than before. This started when she dropped Mtx and added Aza. So far no more improvement than current and we get our new team of docs on the 8th of August so we will see what can happen. It would be so great if Aza is the med that finally makes things better managed for our kids.

lezza. You need a maintenance drug like Aza as you can't be on Prednisone long term. Sorry you had to join the gang here but most people are awesome and will help with info where we can. If you look at my signature you can see my kid has been on almost all the Crohns meds available to kids. I hope Aza is the right one fir you and you don't have to do trial & error.
 
So glad she's feeling better! I've heard that it can take more than 3 months to work -- I have a friend who, after 9 months of being on Imuran, responded miraculously and got her life back (and she isn't on biologics or anything else, just the Imuran)! So I'm hopeful.
Hope the new team of doctors have LOTS of suggestions for D!
 
Here is one article that discusses monitoring of thiopurines and outlines a widely accepted schedule for safety monitoring (see the table in the article).

http://www.healio.com/gastroenterol...6-a430-d735ef89a8d7}/how-do-you-monitor-patie

That said each doctor will do what she feels best with a given patient.

My son's doctor followed the monitoring schedule that's given in this article. We had no problems running up to therapeutic dose which I am sure helped.
 
I'm on Imuran and am officially in remission (aw yeah screw you Crohn's) and that took what seemed like hardly any time at all. I was only diagnosed last July. I still get the odd symptom but that's usually because I ate something I shouldn't have. Once I stop eating the offending food, things go back to normal.

As for blood tests, I had one every fortnight for the first six weeks, then one every three months, and now I'm on one every six months. This did come about with a lot of complaining and whining because all my levels had been perfect since I'd started on Imuran and tbh the blood tests were stressing me out and making me ill - I actually blacked out during one of them. I have to have one in October (bleh) and if the levels are fine for that I'm going to push for one a year unless something goes wrong.

My doctor told me if Imuran is going to mess me up, it would have done it already. There are a few side effects but those settle down and the main one, at least for me, was nausea. Counter that by eating a slice of your favourite gut-friendly cake at night and then instantly taking your Imuran, then going straight to bed. The Imuran makes you tired and you'll sleep through the worst of the icky feeling.

That said, I don't feel sick when I take it any more. The only time I got sick was about a month ago when I couldn't get Imuran and the pharmacy gave me a different brand of azathioprine, which made me feel nauseous when I took it and also caused me to have gut pain, 'the runs' and a weird lump of mucus (yuk I hate that word!) appear in my throat. Since I got back on Imuran a week ago I'm a-ok.

So yeah, everyone's different when it comes to aza and blood tests etc.
 
Sounds like im going to have fun times ahead NOT lol having it at night then going straight to bed might help thanx for that but then again Iight grease through it I'm on predisone ATM and the only side effect I'm getting is hunger and can't sleep ( touch wood) I don't have the hair falling out has I only just got it back I was diagnosed with alopeica about 6 years ago lost a lot if my hair eyebrows lashs now they coming back
 
How is everyone's iron level on Imuran/Aza? I know iron is an issue with Crohns in general but only since my kid started Aza has she had such a dip so low in her iron. Looking like we will be doing iron shots...
 
SupportiveMom said:
How is everyone's iron level on Imuran/Aza? I know iron is an issue with Crohns in general but only since my kid started Aza has she had such a dip so low in her iron. Looking like we will be doing iron shots...
Click to expand...

Since starting aza my iron levels are good.
 
SupportiveMom -- My daughter's iron levels are ok (hemoglobin is slowly rising!). I've heard iron injections are painful, but M was able to have iron infusions two years ago. Perhaps that's an option for D?
 
I'm on iron supplements but then I'm anaemic anyway and have been taking them for years so not sure if the crohn's is making any difference to those!
 
I am actually baffled by her crohns right now. It must be active but she is almost symptom free. Her blood work says differently. Her CRP is high (I don't know the #'s. New receptionist was bad about relaying info), her red/white blood cell counts were ok, but her iron was very low. D has no blood in her stool we see, is down to 5-6x bathroom trips, and pain is much less. Only since starting Imuran has the blood work come back like this. Trying to determine if crohns is becoming more active again or side effect of the meds. My gut is telling me the reprise we have had since June is coming to an end...
 
I've come to discover symptom free doesn't mean inflammation free.

I hope this is just a minor blip in the road.
 
DJW, this is the first time in 2 years she has been relatively symptom free. I'm afraid I'm about to learn what you have discovered. I am grateful for the last 2 months, and want to do whatever I can to ensure whatever this is remains a blip in the road. 2 months of some normality in 2 years is not enough to get a life back. I want to stretch this for as long as possible.
 

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