• Welcome to Crohn's Forum, a support group for people with all forms of IBD. While this community is not a substitute for doctor's advice and we cannot treat or diagnose, we find being able to communicate with others who have IBD is invaluable as we navigate our struggles and celebrate our successes. We invite you to join us.

Dr. wanting to start 6MP WITH my cimzia

I had a colonoscopy done a couple weeks ago which showed inflammation or as my doctor said "Your colon is really angry". I'm currently on Cimzia and have been on it for about 4 years. My doctor is wanting to add 6mp to the mix and I am a nervous wreck about it after reading online. I had my blood drawn today to check my liver and will have a follow up in about a week and a half to see how my results were and if I am a candidate for the drug. The first thing he told me was the chance of lymphoma. Taking chemo and then having a risk of cancer is so scary. I haven't eaten much since my appointment and have been so nauseous. I know this isn't good for my already flaring Crohn's but both of these meds have some crazy side effects and it has me so nervous. He also wants to do another loading dose of the cimzia. he wants to do it once a week for a month.

Has anyone taken these meds together? What exactly does the 6mp do for my Crohn's? I've done a lot of research online but am having a hard time understanding how it will help my Crohn's.

Thanks for any help of insight! :)
 

DustyKat

Super Moderator
:ghug: I’m sorry to hear that you are flaring. :(

6MP as a drug used to treat IBD: It’s action is to suppress the immune system and therefore dampen the chances of the body attacking itself which is how most believe autoimmune diseases work.

You will find many members are on what is called combination therapy, that is a biologic like Cimzia and an immunosuppressant like 6MP. The reason many GI’s use these drugs in combination is twofold:

1. Many studies show that those with Crohn’s who receive combined therapy have significantly higher rates of mucosal healing and therefore remission than those on monotherapy.

2. The use of an immunosuppresant can decrease the buildup of antibodies to the biologic.

The thing to try and establish is why the Cimzia isn’t working and I assume from the treatment plan your GI has for you he thinks you are a secondary non responder.

There are two types of non responders, primary and secondary:
A primary non responder is one who no longer responds to action of the drug and in that case a change to a drug with a different action would normally be called for.
A secondary non responder is a person who may not have adequate levels of the drug in their system or has built up antibodies. The fact that the GI is escalating your dose and wanting to introduce 6MP would put you in this group.

I don’t know enough about Cimzia to know if drug levels and antibody levels are available for it. Do you recall having blood tests for either of these things?
 
Thank you so much for the response. My dr just ordered some labs for me and i got those done on july 1st. I'm not sure what he all tested for but he said my results were normal. I think i may ask his office for all my medical records so I can go through them.

I see that both of these drugs can cause lymphoma and that has me an absolute wreck. I didnt realize Cimzia had that as a side effect. I can't stop crying and thinking about it. I lost my mom to cancer 7 years ago and having 2 little ones, the thought of cancer being the side effect of BOTH of my meds has me scared to death.

Do you know if most patients who are put on both meds, are they kept on both until they start having issues/ a flare or is just to try and get the flare under control and then you go down to one medicine? It looks as though the 6MP is a more long term maintenance drug and it would be something I would stay on, if it worked. I have A LOT of quesrions for my dr. But my appointment isn't until august 30th and right now I'm just worrying myself sick. I see some people take cimzia eveey 2 weeks instead of once a month, i plan to ask him if that's an option.

Thank you for the reply, so much. It helped me to understand better, for sure!
 

Scipio

Well-known member
Location
San Diego
Being on 6mp alone or combo therapy with a biologic like Cimzia is pretty routine. The 6mp might have two hoped-for effects. It's an immunosupressat and might help knock your Crohn's down and help keep it under control. And it might also suppress any possible immune response against the Cimzia and thus make the Cimzia work better and for longer.

Often combo therapy is started with both drugs right off the bat in an attempt to prevent any reaction against the Cimzia from occurring in the first place. For whatever reason your doc chose to start with biologic only and then add the 6mp when if needed. Whatever the case it's probably worth a shot. If that doesn't work I'm guessing the next thing will be to switch to a different biologic.

As for the lymphoma risk, at age 25 your risk of getting lymphoma from the 6mp is very, very low. It's the older patients who are at greater risk for that. You've probably got another 25 or 30 years to go before it be advisable to forgo the 6mp.
 

Scipio

Well-known member
Location
San Diego
Also, the blood tests you had that were normal were probably the TPMT test to see whether you have normal or low amounts of the enzyme that metabolizes the 6mp. If you had a low level you would not be as good a candidate for 6mp therapy.
 
I really appreciate all the information. You guys have helped me to better understand what the drug does and how it could help my crohns. I'm actually 29 now (need to update my signature), but still way younger than that timeframe. My doctor mentioned that lymphoma was more of a concern for young males...

The bloodwork that i got the normal results for was just my routine bloodwork. I just had my blood drawn yesterday for the TMPT test and will get those results on August 30th which is when I will start the 6MP i assume, if mine results come back okay along with the loading doses on cimzia if my insurance covers it again.

I cannot thank you guys enough for the information, i have been worrying myself sick. I have a lot of questions for my dr still but you guys have eased my mind a little bit.
 

Scipio

Well-known member
Location
San Diego
There are two types of lymphoma associated with azathioprine or 6mp use: regular lymphoma (usually a B-cell lymphoma) and hepatosplenic T-cell lymphoma. It is the hepatosplenic T-cell lymphoma that is an issue for young males. Doctors are particularly concerned about it because it is a very aggressive and deadly form of cancer. The regular lymphoma is the one of more concern to you, and as I said, the risks of that for you are very low for someone your age.
 

DustyKat

Super Moderator
The risk of HSTcl lymphoma is very, very, very low. I understand that is of little comfort though. :hug:

I don’t have Crohn’s, both of my childen do, and I have a son on combined therapy that is right in that target group for HSTcl. Do I worry about it? Damn straight I do but unfortunately like many things in life Crohn’s is a continuing story of weighing up the odds and choosing the lesser of two evils. Crohn’s has the potential to be just a devastating as the side effects of these drugs if not treated appropriately. I don’t wish to scare you, it’s just that I have seen the other side of this disease and its not something I want to ever see again. So in our case either you take the risk with the drugs or due to type of disease my son has, aggressive, fistulising, which left untreated or undertreated has the potential to kill him too. :(

As Scipio has said, you are out of the realm of what the studies point to as being the high risk factors leading to HSTcl. I would focus on nipping the disease in the bud so you can be in the best possible health to enjoy your little ones and run around like a mad thing with them. :lol:
 
Thank you guys so much! You have no idea how much you have helped me. My crohns is very aggressive also and it came very suddlenly when I got diagnosed and i ended up in exploratory surgery and on a breathing machine so no meds is definitely not an option for me either. I was just hoping to get some info to help me "cope" with the idea of being on both of these meds.

Hope your kids are feeling okay💚

We will see what my dr says on the 30th!

Thanks again so much!
 

DustyKat

Super Moderator
:ghug:

Please just know that you are not alone in your fears when faced with making these decisions. They freak us all out! :eek2:

Good luck with the appointment and keep us posted with how you get on. In the meantime, sending you loads of well wishes that you are able to reconcile with the decisions that need to be made. :heart:
 
Top