Imuran, AZA, or Methotrexate? Weighing them all.

[nogutsnoglory]

My doctor wants to add another medicine on top of Cimzia. 6mp did nothing for me so I won't use that one.

What are the positives or negatives between Imuran, Azathioprine and Methotrexate besides Meth being an injection?

 

[Kev]

I think Azathioprine and Imuran are one and the same... Imuran being a brand name of AZA
(could be wrong... been wrong before.. but not in this millenium) ;-)

I didn't fare well on AZA (Imuran). Put me in the ER, despite regular bloodwork. My only other option would have been Metho... but it scared the daylights out of me and my GI, so she agreed to put me on LDN.. and the rest is history... eeer, mystory.

 

[kh216]

Imuran and Azathioprine have the same active ingredient as 6mp. Methotrexate is also an immunosuppressant and it is given by injection. I personally have not used methotrexate but there are others in this forum that have so hopefully, they will post too.

 

[superzeeman]

I am on metho, pill form, and have had 3 doses and my liver is not happy as of last test. I have another blood test tomorrow and will see what happens. I am scared of the stuff frankly.

 

[nogutsnoglory]

So Mercaptopurine is essentially the same as Imuran and AZA? Are the side effects the same for all 3 of them? Methotrxate really scares me but 6mp didn't help me and I always got sick on it.

 

[rollinstone]

Yea, well Azathioprine is converted into 6mp in the body anyway, so it's the same thing essentially, how long were you on 6mp for? It generally takes up to 3 months before you start feeling its benefits.

 

[seebee]

Though Imuran/Azathioprine and 6mp are essentially the same, for some reason if someone doesn't do well on one, they may be fine on the other.

 

[nogutsnoglory]

I was on 6mp for over two years but ended up with major surgery.

 

[rollinstone]

Sorry to hear that did you get regular tests done while you were on it to measure inflamation?

 

[nogutsnoglory]

The funny thing is my inflammation levels were always normal. Those blood tests are not totally reliable. I was majorly inflamed but ESR and CRP and calprotectin tests didn't show it.

 

[SarahBear]

MTX comes in pill form and injections. It's my understanding that there are far less side effects with the injection. That's what I did, and I had a very good experience with it. I don't remember having any side effects at all, but then again I was also on Pred at the time so for all I know, half my body turned green and I just couldn't see it over my predmunk cheeks. But I did go into remission around the end of my methotrexate course (I had to stop as I lost my medical insurance).

Is your doctor suggesting one over the others? Are you leaning in any direction?

Whatever you chose, I hope it works for you! :hug:

 

[alex_chris]

My doctor wants to add another medicine on top of Cimzia. 6mp did nothing for me so I won't use that one.

What are the positives or negatives between Imuran, Azathioprine and Methotrexate besides Meth being an injection?

As said above, azathioprine is the drug and imuran is just the brand name (similar to Cimzia being the brand name and Certolizumab pegol being the drug).

I can't say anything about methotrexate, never did much research in it, although I know doctors are using it in addition to biologics.

What I can say is that there is that quite well known 2010 study on combination therapy between biologics and azathioprine. That was not done with Cimzia but Remicade. In essence it said that aza gets 1/3rd of the patients into deep remission, biologics a bit over 40%, but the combination of them (2.5mg aza per kg body weight AND Remicade at 6mg per kg body weight) got 57% of the patients into deep remission while having the lowest number of severe infections (3%) in the time period reviewed.

Ok, in other words, I would try the Cimzia / aza cominbation for a few months. If it works fine, if it doesn't you can still go for methotrexate (which is much heavier drug as far as I see it).

P.S. you take aza in form of pills on a daily basis, it takes 2-3 months to kick in

 

[nogutsnoglory]

My biggest concerns are getting sick because on 6mp I was constantly under the weather and getting upper Respiratory infections.

I don't like the idea of an injection but the lymphoma scare with AZA and a biologic scares me even though rare.

They all sound scary and dangerous bit since 6mp didn't work I'm leaning towards the thinking that Imuran won't either.

 

[alex_chris]

My biggest concerns are getting sick because on 6mp I was constantly under the weather and getting upper Respiratory infections.

I don't like the idea of an injection but the lymphoma scare with AZA and a biologic scares me even though rare.

They all sound scary and dangerous bit since 6mp didn't work I'm leaning towards the thinking that Imuran won't either.

As you know there is a reason docs switch you from aza to 6mp or the other if one doesn't work. For some reason people react differently to those drugs.

The 2010 study concluded that combination therapy doesn't pose any higher risk than biologics or aza alone. You can google that study, it's quite interesting.

 

[rollinstone]

The funny thing is my inflammation levels were always normal. Those blood tests are not totally reliable. I was majorly inflamed but ESR and CRP and calprotectin tests didn't show it.

That's really scary did you have any symptoms while your cal protectin came back normal? That really does make me worry because all my tests have come back normal recently, I'm considered in biochemical remission, no crohns symptoms, healthy looking stool etc but I still get pains in the stomach every so often.

 

[ron50]

I inject the equivalent of 20mg of mtx every sunday night. I take megafol on monday and tuesday. I suffer mild nausea for two days afterwards. Not throwing up just a bit quesy.I was on it a few years back for psoriatic arthritis and kidney problems. At the time I was losing 3grams of protein a day thru my kidneys. It helped the arthritis and brought the protein loss down to .375 of a gram. Unfortunately they stopped it because of chronic diahorreah. I never lost that and have since resolved it with questran . I hope the mtx helps this time as my protein loss is over 4 gramms and the arthritis and ankylysing sponndylitis is killing me. My biggest problem is that even when kidneys and arth is under control I still have severe neuropathy in both feet legs and left hand and arm. I think the neuropathy is the result of chemo-toxcicity from colon ca treatment. Trouble is mtx is a chemo agent and may be making the neuropathy worse. Ron.