Combination therapy: stelara & imuran?

[chronic_rambles]

Hi there

I am currently on stelara (every 4 weeks) which is failing even after a recent “reload” dose. My Gastro doc now wants to add Imuran into the mix.
Is anyone else on this combination? Have you had success? Thanks.

 

[DCCrohns]

I am on this mix - Stelara every 4 weeks and 150mg of Azathioprine/Imuran daily (as well as Cipro/Flagyl). My disease is primarily fistulizing and, while it hasn't resulted in healing, it has kept inflammation in check. When we added Imuran, I started at 50mg/day and we upped it over time. The only major side effect I have noted has been increased exhaustion.

 

[Adam1971]

I am curious if anyone here knows if the body develops antibodies to stelara, similar to other biologics, that cause it to lose effectiveness. If this was happening in this case, does it make sense to continue with it with or without Imuran? When a biologic is losing effectiveness, when is time to switch vs adding another medicine. I'm just curious in general and wondering what the doctor is thinking specifically in your situation. Thanks for considering.

 

[DCCrohns]

You can develop antibodies to Stelara (per manufacturer, <3% do). Have your Stelara levels been checked by chance? I think there may only be a lab or two that does this but it may be helpful to know how your body is metabolizing it.

I think once it isn’t working, adding Imuran or another may not be the most helpful. When ai started failing Humira, we went to Stelara with Imuran as the next step.