How do I choose the right medication?

[Yanick]

I am confronted with a difficult choice, and I simply can't decide. Hoping the Crohn's community can help out.

Overall, my symptoms are pretty mild. Sure, there is occasional bleeding, pain, diarrhea, but overall, these are things I can live with with relatively minimal impact on my life. Overall, I feel better when I follow the SCD. The only thing I am taking right now is Asacol. For a while, I've been resisting stronger medication. Finally, my doctor did two colonoscopies within 1 year of one another, and told me that my actual disease (inflammation) is not getting any better on the diet or with Asacol, and I need to consider switching to stronger medication.

The options are:
1. immuno-suppresant
2. biological modifier
3. two meds together.

Overall, I have a lot of anxiety when it comes to medication, and the more research I do on the options in front of me, the less I feel like taking any of them.

How do I decide to accept the consequences and risks associated with meds, when my symptoms are not really that bad? How bad are the risks of infection? Lymphoma? I am just looking to see if someone could share their journey and the thought process, especially if the situation is somewhat similar to mine.

 

[kh216]

Based on my personal experience, I would try an immunosuppressant first, such as Imuran or 6mp. The pros with them are that they are more convenient as they are in pill form and generally (but not always (depending on the individual) have less side effects. Also, these medications have been around for a longer period of time so doctors are more accustomed to prescribing them. The cons with immunosuppressants are that they generally take 3 to 6 months to work and you need to get blood work done at regular intervals to make sure that your liver function levels are okay and your white blood count does not go too low. If the blood work is a little abnormal, the doctor will generally lower the dosage. If you were having a major flare and were in a lot of pain, then I would say go with a biologic medication to get more immediate relief. However, it sounds like you are controlling most of your symptoms through diet and just need an extra medication to control the inflammation. FYI - I am using 6mp and Asacol now and I am doing well with this combination :ysmile:

 

[rygon]

you can either go for the lower strength meds (azathioprine), see how that works and if it doesnt go for higher strength meds .. or (and I think the new way of thinking is this), go for higher strength 1st, get on top of the disease, then you can go onto lower strength meds. Personally I wish I tried this approach.

Im on remicade an imuran + mezavant and its sort of working (start feeling bad a week before needing another dose of remi)

Just remember that although there is a higher risk that you could get complications, the risk is very slight, and that there is also a risk of leaving the disease untreated (bowel cancer springs to mind). you have to weigh up the risks on both sides against the quality of life between each and then decide (no point living to 90 if you have to stay in bed every day in constant pain)

 

[kh216]

I agree with Rygon. David posted a thread which basically stated that mesaslamine(sp?) medications are not enough for treating Crohn's Disease so different medication is needed.

 

[Yanick]

Here is what's still confusing. All the research that I did on the stronger medication options state that it's intended for treating moderate to severe Crohn's cases. After both recent colonoscopies, my doctor told me that based on what he sees, my Crohn's is mild to moderate. Am I looking to swat the fly with a hammer? I realize that chances of serious complications are pretty small, but so are the chances of getting something like Crohn's. I guess pulling one "golden ticket" made me weary of dismissing seemingly improbable odds...

The problem is: if I try the new medication and end up getting stuck with serious consequences or side-effects, would I feel that it was worth the risk? I guess you can tell I am having some anxieties around strong medication...

 

[KWalker]

That is exactly how I felt/feel. I stopped taking medicine in 2010 when I thought I could do it on my own. I did so well for awhile, and then last year I ended up having two surgeries for serious abscesses which still haven't healed, and I have a new one forming now. That is my only symptom. While I feel great physically, I really had no idea what kind of damage was going on inside.

Long story short, I have an appointment to discuss medicine on Wednesday, December 5 and my 3 choices are essentially Imuran, Remicade or Humira. I hate feeling defeated and often contemplated cancelling the appointment but to me its worth it right now to go back on medicine.

 

[kh216]

KT Walker, you might want to read David's excellent post about abscesses:

http://www.crohnsforum.com/showthread.php?t=20887

He wrote that you should not be on Remicade or Humira with an abscess because it will cause the abscess to close too quickly. He wrote that you should be on an antibiotic to fight infection and try to get it drained. Then you could go on an immunosuppressant like Imuran.

 

[muppet]

I'm still a big fan of the bottom up approach despite overwhelming resistance in the community both patient and scientific. ;-)

My feeling is that unless you are in danger of sustaining severe damage without a quick resolution, you have time to give a less dangerous medication time to work. Also, the immunosuppressants and ASA drugs tend to have a longer therapeutic window for people than the biologicals do. The average on biologicals seems to be around 5 years before they no longer work for the patient, and then you have to switch again. For people in dire straits, they're a lifesaver, though.

 

[KWalker]

KT Walker, you might want to read David's excellent post about abscesses:

http://www.crohnsforum.com/showthread.php?t=20887

He wrote that you should not be on Remicade or Humira with an abscess because it will cause the abscess to close too quickly. He wrote that you should be on an antibiotic to fight infection and try to get it drained. Then you could go on an immunosuppressant like Imuran.

Kh216: I think that was a typo lol. My name isn't KT, nor am I a girl lol. Anyways, I read that thread. There's a ton of conflicting advise as to what works for abscesses. Some say Remicade/Humira are absolutely required, some say not to use them. The problem is, if I were to leave my abscesses I would have to go on the antibiotics (cipro and flaygl) essentially forever and I've had my abscess for a year now with continous periods of antibiotics and they work while they're in your system but the second they're no longer in your system the drainage starts again. We need something more than just Cipro and Flagyl because I know from first hand experience those are not enough.

 

[David]

KT Walker, you might want to read David's excellent post about abscesses:

http://www.crohnsforum.com/showthread.php?t=20887

He wrote that you should not be on Remicade or Humira with an abscess because it will cause the abscess to close too quickly. He wrote that you should be on an antibiotic to fight infection and try to get it drained. Then you could go on an immunosuppressant like Imuran.

Awwwwwwwwwwwwwww CRAP!

I didn't actually write that. I, "took it over" because the person who wrote it decided they didn't want to be a member here anymore and it was an important sticky.

I'll update it but based upon what I've been reading lately, drainage of the abscess FIRST, then antibiotics with a biologic like Remicade or Humira is often best.

I'm sorry

KWalker, please read this thread if you haven't already.