Humira vs Azathioprine

[NoNameNoFace]

When I was diagnosed last November my doc put me on 8 tablets of pred a day and one 50 mg of aza, I felt great for about a month but as my I reduced my pred week by week I slowly felt my symptons come back. So my doc then upped my aza to 150mg. My symptons were completely back and I told my doc so Im currently waiting to hear back from the clinic to be put on Humira treatment, he also informed me that my case is quite severe for my age, Im 23.

Ive also strictly kept to a low fibre diet my dietician give me, over the last week or two I haveto say my pains have eased down, I get some cramps but not long and painful ones like before, although my stool is still loose and I still feel tired and fatigued most days, I also posted on another board that I get trapped wind most days and vomit when I play sports. My appetite could also be a bit better.

Could this be the aza finally and slowly starting to work, as it does say it will take 12 weeks to notice the effects? Well its been about 12 weeks since Ive been on 150mg.

Do I let my doc know? or else just go ahead with the humira and be completely relieved of symptons? Could the aza be working?, althout bar the pains all the symptons are still there, they could go away with more time?

 

[Manzyb]

I can't tell you if you should take both or not. However, I did feel great on Humira. I never took that and aza together though. You could always give it more time and see how you feel. I'm usually way too impatient for that and do everything I can to get flares under control as soon as possible

 

[NoNameNoFace]

Yea I was thinking that to, just go ahead with the Humira, I've waited a long time to be sympton free

 

[David]

A few questions as the vomiting and fatigue are a bit concerning:

1. Are you getting regular blood work done to monitor your WBC, RBC, and platelets?
2. What clinic is putting you on Humira? It's separate from your GI? Is your main doctor a GI?
3. Have you had your vitamin B12 levels tested? If so, what were they? Are you at all anemic?

Wondering out loud here. I wonder if the Azathioprine + sunlight when you play sports is somehow contributing to your vomiting. That's not what they warn about with the sun and Aza, but the two could be related somehow as Aza definitely increases sensitivity to the sun.

That you've been on the higher dose of Azathioprine for just 12 weeks and you're starting to feel a little better makes me think you may want to try it out for awhile longer by itself to see if it works. Give it a fair shot. Have they taken any blood markers (CRP, ESR, etc) that they can now redo to see if the inflammation in your system is decreasing so they can quantify that there is benefit?

 

[NoNameNoFace]

Thanks for the reply David. I am too concerned about my vomitting, nearly every day over the last few weeks I've felt very nausous!

Yes my blood gets tested every 2 weeks, I havent heard nothing back so I assume its normal?

Im not to sure what way it works, the doctor just said I will be getting put through the clinic for the injections, the clinic is in the hospital. Yes my main doctor is a GI.

No I havent had my vitamin B12 tested at all. Seems the service here in Ireland here isnt as good? :ymad:

When I play sports its at night time, so no direct sunlight. Although over the last week or so we have had brilliant weather for Ireland and warm temperatures, I was out working in it, I didnt know aza made you sensitive to sunlight!!! could be causing the vomitting, something deffo night right in my stomach!

I am too wondering should I stick it out with the aza, I will discuss all this with my doc at my next check up. I havent even heard of blood markers, they deffo havent done any tests like that on me to see if my imflammtion is reducing:S
The cramps are still sore, but not as bad, but my stool is still loose, still feel fatigued and my appetite isnt that good!

 

[David]

If you're fatigued and haven't had your vitamin B12 checked, that's the next step for sure. And get the actual results.

 

[MrsZ]

I have been taking Aza & Humira for over 3 years. No issues/side effects with either to date.

 

[SMSIRL]

While it is not uncommon, the concomitant use of azathioprine and biologics apart for a transitional period is questionable. These drugs severally carry an increased risk of displastic changes and subsequent disease. The fda warnings of increased risk, which both sets of drugs carry, highlight concomitant use as being implicated. Whether this is to cloud the issue so as to imply that it is the other drug class that is causal for the excess cases of hepatospleic t-cell lymphomas etc doesn't alter the fact that concomitant use should be minimised or avoided.
These adverse effects are not like the usuall side-effects, they are stealth illnesses that manifest only after considerble damage has been done. They may lay dormant for years. Therefore, for my part, I would want very good evidence and no alternative before I would even consider being on both drug classes at the same time.
When I went on azathioprine an subsequently reached therapeutic levels it took about 5 months for me to see maximum effect. Saying that, Crohn's has to be one of the most individualistic syndromes I know.

PS. If people could avoid using abreviations for med names, given the gravity that a mixup might portent, it would be better. Some abreviations map onto more than one drug. For example AZA has several different uses in varying medical settings and geographical regions. if they are used, at least once in every post the complete form aswell as the abbreviation should appear together.

 

[M101]

Hi there

I was in a similar situ for a while - hanging in there on Aza (6MP in my case) and having odd discussions about Humira. I think its all a balancing act, only you know how you feel and if you can get through life at the moment.

But one piece of advice I was given, which was helpful is to remember that Humira could be the last treatment option avaliable and if you take it up too early and something happens, there will be no other options left. With this in mind, I hung on for about 8 months on Aza and I did have points when I thought it was working (one time in particular I was so well for a week, I got super excited I was better!) but now know that it hasnt worked (recent scope results). I am now at the point where I have no other option than to go for Humira.

I hope you figure out whats best for you soon, such a long struggle.

Em xx

 

[calligator]

My understanding is that it does take a while for Aza to kick in - I was started on Budesonide until they decided what medication to take and when they did give me Aza I had to keep up with the steroids so there was an overlap of the medications and then the idea was to slowly come of the steroids and just take Aza. Unfortunately the Aza didn't agree with me and had to stop taking it so am now waiting to start Humira.