Imuran vs pentasa vs salofalk

[Mumof2]

I had a colonoscopy yesterday to check on my crohns activity level. I have no active disease in my large bowel (which has improved since last check :dance I have active disease in my terminal ileum. My specialist has recommended I start on imuran. I am currently on 1g salofalk per day. I'm reluctant to start on imuran as I have very mild disease with very few symptoms. I've read that pentasa starts being digested from the duodenum (rather than the terminal ileum like salofalk). What would you guys suggest I do? I'm thinking I should give pentasa a try if I can. Anyone else in Australia taking pentasa?

 

[Essieluv]

Depending on what your doctor says, Pentasa may be an option for you. However, keep in mind that it is one of the mildest drugs for Crohn's and can take a very long time to kick in. If you have active disease, you may want to start on a bigger "horse power" drug to kick the inflammation's butt quick and get everything under control fast.

 

[Nancye50]

I'm not familiar with salofalk so I'm interested to see what people say. I'm new to Crohn's and fighting the start of Imuran as well.

 

[DustyKat]

Hi mumof2,

I imagine the doctor may have suggested Imuran as the 5ASA's don't appear to be working on the terminal ileum. As you have said, Salofalk is designed to released in the terminal ileum and as such should treat inflammation located there. I doubt moving to Pentasa will make a difference where Salofalk hasn't.

My son is on Pentasa, he is also on Imuran, simply because he has had his terminal ileum resected so no point using Salofalk.

The effectiveness of the 5ASA's in Crohn's is questionable and the large bowel does tend to have a better response if there is going to be one. You may well ask then, why is your son taking Pentasa? :lol: I agreed to its use in the context of ileal disease post surgery. The GI did agree it isn't a brilliant drug but he was able to pull up a couple of studies that gave some positive feedback in this instance. The percentages were far from great but given my son's history even a two percent advantage is worth it.

Have a read of this thread:

http://www.crohnsforum.com/showthread.php?t=36292

Dusty. xxx

 

[ellie]

I understand reluctance about the "bigger guns" when your Crohn's appears to be fairly mild. My disease is colonic only at thus stage, and am controlled on Sulfasalazine at present. It's possibly worth talking to your GI about adding a lower dose of 6mp or azathioprin to continuing 5ASA. As far as I understand, they can be taken together, and I am personally keen to maintain remission with the most minimal drug side effects possible..


HD

 

[Mumof2]

Thanks guys for your responses. I'm really not keen on taking Imuran when I am asymptomatic. The info I've read on Pentasa are convincing me that I shouldn't bother with that. Salofalk has been good to me over the years. I am pretty responsive to it. I adjust the dosage when I start getting symptoms and feel a change quite quickly. I am only taking 2x500mg tablets once a day at the moment which is possibly why I have active disease. The minimum dose recommended is 1.5g a day.
I've been on minimal dosage while having children and breastfeeding. Now I am finished making babies and finished breastfeeding so I could increase the dose to the recommended 3g over two doses and see how that goes.
As I said, it's hard to tell when I have only an occasional symptom.
What do you think DustyKat?

 

[DustyKat]

I see two main points of consideration mum:

1. As an adult with a ?mild presentation I can understand your hesitancy to move up to the next level of treatment. It may well be that the 5ASA’s will serve you and serve you well.

2. With Crohn’s you need to look at the whole picture objectively and in doing so take into account objective, clinical and pathological markers as they may tell very different stories to what you are feeling and seeing. In a nutshell you need to stay on top of any ‘silent’ damage that may be being done.

With these two things in mind I would start by looking at inflammatory markers, both serological (ESR and CRP) and faecal (Faecal Calprotectin) plus having baseline bloods done (FBC, LFT’s, UEC’s) and while you are at it have B12, Iron Stores, Vit D, Magnesium and Zinc levels done. With TI involvement you have the potential to be deficient in any one of those I have listed from B12 on.

Now, armed with the information of the inflammatory markers I would decide from there. Since you have stated you are not on the optimum dose of Salofalk, don’t up the dose before getting the bloods done, then if markers are normal or not hugely elevated then I would likely increase to the maximum dose of Salofalk and repeat the inflammatory markers at regular intervals, say monthly to start if there is no change in your condition, to gauge the response to the Salofalk. If the markers remain normal or reduce to normal then after discussion with the GI and if you both agree then stay with the status quo.

Now if the markers are quite elevated at the outset or fail to respond to the increased dose of Salofalk then you really do need to move up to Imuran. I know Salofalk has been good to you up till now but don’t ever become so enamoured with one treatment, no matter what it is, that you can’t see your disease for what it is.
Under treated Crohn’s has the potential to be a very insidious and dangerous thing due to the simmering inflammation that remains unchecked.

I don’t know if Prednisone or Entocort has ever been in the equation much in the past for you but if there is a need to step up in your treatment regimen then it does have the advantage that these level of drugs (Imuran) and above are steroid sparing and that is never a bad thing.

I am not a doctor so please take anything I say as my opinion only.

Dusty. xxx

 

[Mumof2]

Thanks DustyKat. Your post is very helpful. Even though you aren't a doctor, with 2 kids with Crohn's, I'm guessing you would have been up many nights researching and researching what is best for them. I'll take your suggestions to my GP asap and get the bloods done before I see my specialist at the end of May. That will give me some information to share with her.

 

[DustyKat]

You guess right! :lol:

Be sure and get a copy of all your results from the GP if you don’t already do so.

 

[hawkeye]

I'd give the Imuran strong consideration. I was on both Imuran and Salofalk prior to my resection. I am off them now until my post surgery follow up with the GI.

I think both have served me well, but I give credit to the Imuran for maintaining a good "remission" through the 1990's up until about 2009 when things became more active.