can anyone tell me how effective Imuran is over Remicade (if at all).Teenager thinks he wants Imuran solely based on the fact that its a pill he can take on his own, doesn't care about anything else. Hes just been diagnosed with crohns and perianal (both very mild ) and is "feeling fine".(Dr wants Remicade)
Effectivness of drug: Remicade v. Imuran
- Thread starter Clapton
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theOcean
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I know I've responded to you about this before, but I felt that Imuran did absolutely nothing for my perianal disease. I kept convincing myself I was "feeling fine" too when I was still new to Crohn's, and that's how I ended up in the hospital for a month.
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I've responded as well, worked for my husband. Did not work for my son.
I don't know Clapton what is the GI's recommendation? Did he say you could try Imuran but remicade would be best?
Maybe if he is dead set on it and GI agrees you could set a time frame and certain factors being met? normal labs, no symptoms, clean scopes, etc. There are quite a number who have done the step up treatment (starting with the mildest and moving up the ladder till you get a treatment that works).
Hubby had surgery on perianal abscess in 2003 and started on Imuran at that time, he has been good since then so Imuran can work and does work for many people.
What does your gut tell you? Choosing/Helping to choose these meds for our kids is so hard, it must be really hard when your son is "this close" to making those decisions on his own.
Can you all sit down with the GI and discuss the choices/options and possibilities. Maybe the GI can shed some more light on why he is recommending remicade over Imuran.
My son did not want to start remicade every time we went and discussed treatment option, he always said as long as it's not remicade I'm okay. Not really sure why he was so set against it. But the GI really explained why he wanted him on remicade (I of course got the final say) and I was undecided myself but after listening to him it was a fairly easy decision even though I still questioned it up until the first infusion. It has been our wonder drug for him.
I don't know Clapton what is the GI's recommendation? Did he say you could try Imuran but remicade would be best?
Maybe if he is dead set on it and GI agrees you could set a time frame and certain factors being met? normal labs, no symptoms, clean scopes, etc. There are quite a number who have done the step up treatment (starting with the mildest and moving up the ladder till you get a treatment that works).
Hubby had surgery on perianal abscess in 2003 and started on Imuran at that time, he has been good since then so Imuran can work and does work for many people.
What does your gut tell you? Choosing/Helping to choose these meds for our kids is so hard, it must be really hard when your son is "this close" to making those decisions on his own.
Can you all sit down with the GI and discuss the choices/options and possibilities. Maybe the GI can shed some more light on why he is recommending remicade over Imuran.
My son did not want to start remicade every time we went and discussed treatment option, he always said as long as it's not remicade I'm okay. Not really sure why he was so set against it. But the GI really explained why he wanted him on remicade (I of course got the final say) and I was undecided myself but after listening to him it was a fairly easy decision even though I still questioned it up until the first infusion. It has been our wonder drug for him.
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I do know that when my son was diagnosed that our GI said that perianal issues tend to be the most complicated to treat. (My son is not affected in that area). I also know that Imuran can take several months to work and is usually used with EN (liquid only diet) or Prednisone to induce remission and treat the disease until the "pill" starts working. Remicade starts working immediately. MLP (if my memory is correct) talked about a study that showed using biologics like Remicade shortly after diagnosis can actually alter the disease course over a lifetime, making it more mild.
As far as I know Dr.'s don't have the ability to really know what course your disease will take. Someone who is very mild at diagnosis can get bad very quickly, they try to treat the most likely scenario and are cautious not to allow things to get worse. The worse things get, the harder it is to attain remission, so starting out with symptoms relatively mild is such an advantage. It is a bit of a roll of the dice to hope things stay mild, it could happen but what if it doesn't?
I understand struggling with this decision. There aren't really any great options with crohn's treatments. It seems they all have their pros and cons. My husband and I felt like we needed to trust our Dr. He has treated thousands of kids and after decades of treating crohn's he knows what works and what doesn't better than we could understand. Our GI recommended Prednisone and 6mp. I know he had many patients on remicade and I am not sure how he determined which one he recommended. Remicade is more effective but also more expensive and invasive. My thoughts after years of researching and helping my son through dealing with this disease is that the first few years after diagnosis are usually the most critical and severe. Once they get things under control they tend to stay there but some will have a difficult time in the beginning getting things to the point of real remission. I think DR.'s weigh the cost, invasiveness and potential side effects to steer some towards Imuran. Otherwise, hands down I think most would say Remicade is more effective.
((((hugs))))) those first few months after diagnosis and figuring things out is not a fun place to be. I hope you find something that works for your teen!
By the way, this is the way I understand the disease, I am not a Dr. and although I try to give only accurate information this is totally how I have come to understand things. I totally welcome any form of discussion or correction.
As far as I know Dr.'s don't have the ability to really know what course your disease will take. Someone who is very mild at diagnosis can get bad very quickly, they try to treat the most likely scenario and are cautious not to allow things to get worse. The worse things get, the harder it is to attain remission, so starting out with symptoms relatively mild is such an advantage. It is a bit of a roll of the dice to hope things stay mild, it could happen but what if it doesn't?
I understand struggling with this decision. There aren't really any great options with crohn's treatments. It seems they all have their pros and cons. My husband and I felt like we needed to trust our Dr. He has treated thousands of kids and after decades of treating crohn's he knows what works and what doesn't better than we could understand. Our GI recommended Prednisone and 6mp. I know he had many patients on remicade and I am not sure how he determined which one he recommended. Remicade is more effective but also more expensive and invasive. My thoughts after years of researching and helping my son through dealing with this disease is that the first few years after diagnosis are usually the most critical and severe. Once they get things under control they tend to stay there but some will have a difficult time in the beginning getting things to the point of real remission. I think DR.'s weigh the cost, invasiveness and potential side effects to steer some towards Imuran. Otherwise, hands down I think most would say Remicade is more effective.
((((hugs))))) those first few months after diagnosis and figuring things out is not a fun place to be. I hope you find something that works for your teen!
By the way, this is the way I understand the disease, I am not a Dr. and although I try to give only accurate information this is totally how I have come to understand things. I totally welcome any form of discussion or correction.
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I think this is a good presentation that discusses the benefits and risks of many of the drugs used for Crohn's. It does show that not only does Remicade work better than Imuran, a combination of Remicade and Imuran works best (though some doctors don't like prescribing the combination).
http://www.chop.edu/export/download/pdfs/articles/gi-liver/IBDday2014_Grossman.pdf
My daughter was diagnosed at 16 and we went straight to Remicade. I have to say that I'm very glad we did because she is in remission now and her scopes and pillcam looked great! She didn't think it was that inconvenient because she was already doing weekly shots for her arthritis -- in fact, she much preferred the infusions to the weekly shots because then she didn't have to think about it for 5-6 weeks. She quite enjoyed missing school for the infusions - said it was a good chance to nap and watch tv. It's so hard when they're almost old enough to be considered adults because they think they know best and of course, all teenagers seem to be convinced that they're invincible. My daughter's GI spent a long time explaining the risks and benefits of the various treatments.
Could your son's GI explain to him why he is recommending Remicade for him? Perhaps hearing it from someone other than his mom would help.
http://www.chop.edu/export/download/pdfs/articles/gi-liver/IBDday2014_Grossman.pdf
My daughter was diagnosed at 16 and we went straight to Remicade. I have to say that I'm very glad we did because she is in remission now and her scopes and pillcam looked great! She didn't think it was that inconvenient because she was already doing weekly shots for her arthritis -- in fact, she much preferred the infusions to the weekly shots because then she didn't have to think about it for 5-6 weeks. She quite enjoyed missing school for the infusions - said it was a good chance to nap and watch tv. It's so hard when they're almost old enough to be considered adults because they think they know best and of course, all teenagers seem to be convinced that they're invincible. My daughter's GI spent a long time explaining the risks and benefits of the various treatments.
Could your son's GI explain to him why he is recommending Remicade for him? Perhaps hearing it from someone other than his mom would help.
DustyKat
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Hey Clapton,
Imuran works wonderfully well for some but not others as does Remicade but put them head to head and I don’t think anyone can deny that Remicade has a more impressive record. Another factor that would put Remicade ahead in the race in your case is that your son has perianal disease, Remicade is particularly good at treating disease located there. I have skimmed over your other posts and I see that you have mentioned that there has been evidence of a fistula, unfortunately that means his disease has been or is now beyond what would be considered mild.
I understand what your son is saying about feeling fine but does he truly feel that way or have his symptoms been so insidious that the abnormal has become normal without him realising it. Do you know what I mean?
What your biggest challenge is now is compliance. If your son flatly refuses to take Remicade then there is no choice but to go to Imuran. If he does go that route then he has two things to take on board. Firstly Imuran is not a drug that produces immediate results, it will take at least 3 months, and for some as long as 6 months, to become fully therapeutic. Secondly he must go into this decision with his eyes wide open and be objective about the results the drug is producing. If Imuran isn’t cutting it then he needs to move off it and onto something else, the GI needs to give him a clear time frame in which the drug is deemed effective or not.
As to my children? Well Imuran has worked very well for them but there is a very clear distinction in our case. Both of my children needed resections due to complications. The surgery resulted in a disease free bowel and remission, so in their cases Imuran was working off a clean slate.
Good luck mum, life as a teenager, and with a teenager :lol:, is hard enough without Crohn’s being thrown into the mix! :ghug:
Dusty. xxx
Imuran works wonderfully well for some but not others as does Remicade but put them head to head and I don’t think anyone can deny that Remicade has a more impressive record. Another factor that would put Remicade ahead in the race in your case is that your son has perianal disease, Remicade is particularly good at treating disease located there. I have skimmed over your other posts and I see that you have mentioned that there has been evidence of a fistula, unfortunately that means his disease has been or is now beyond what would be considered mild.
I understand what your son is saying about feeling fine but does he truly feel that way or have his symptoms been so insidious that the abnormal has become normal without him realising it. Do you know what I mean?
What your biggest challenge is now is compliance. If your son flatly refuses to take Remicade then there is no choice but to go to Imuran. If he does go that route then he has two things to take on board. Firstly Imuran is not a drug that produces immediate results, it will take at least 3 months, and for some as long as 6 months, to become fully therapeutic. Secondly he must go into this decision with his eyes wide open and be objective about the results the drug is producing. If Imuran isn’t cutting it then he needs to move off it and onto something else, the GI needs to give him a clear time frame in which the drug is deemed effective or not.
As to my children? Well Imuran has worked very well for them but there is a very clear distinction in our case. Both of my children needed resections due to complications. The surgery resulted in a disease free bowel and remission, so in their cases Imuran was working off a clean slate.
Good luck mum, life as a teenager, and with a teenager :lol:, is hard enough without Crohn’s being thrown into the mix! :ghug:
Dusty. xxx
