Intermediate TPMT Risk

[Mehita]

Before DS was put on Azathioprine, he did the TPMT test and it came back in the intermediate range, meaning they weren't sure it was going to work for him and he'd have to have labs run more frequently to make sure it wasn't affecting his liver.

Jump to today and he's on Remicade because Aza wasn't strong enough for him. He continued to flare, but his liver tolerated the Aza well enough. Remi testing detected antibodies, though only a 24 and normal is less than 22, but his GI has said we may want to add 6MP or methotrexate to stop/prevent further antibodies from building.

So, my question... keeping in mind the intermediate TPMT, would adding 6MP have the same issues/risks from before? Would it even be worth trying 6MP or, if the need arises, just go with methotrexate? The idea is that the med would suppress the immune system enough to allow the Remi to continue to work. Is one better at immune suppression than the other?

Thoughts?

 

[CrohnsKidMom]

My son tried Imuran at diagnosis, but couldn't tolerate it. The GI said at the time that we would skip 6mp as it was quite possible he would react to it too. I don't know if the risks are the same with 6mp as with Imuran, but apparently if you react to one, it is quite possible you'd react to the other. My son has been on MTX injections for almost 2 years, but we are switching to Remicade now. Our GI prescribes MTX with Remicade for boys, and Imuran with Remicade for girls.

 

[Mr chicken]

One is not better than the other
6-mp would carrying the same risks since its a sister drug to as tmpt is also ran
Add in higher rate of cancer from 6-mp /Aza .
Mtx currently is not shown to have that same risk
Most Gi only use mtx alone or mtx plus biologics for teens especially teen boys for this reason

 

[Maya142]

Our GI prefers MTX too now (for boys and girls) -- thinks it is safer. Given his intermediate TMPT, I think it would very reasonable to ask for MTX should he need it.

That said, we did try Imuran for my daughter since she does have awful side effects with MTX (she has been on MTX several times). When M was put on Imuran, the idea was to prevent antibodies to Remicade, plus knock out the remaining inflammation in her gut and possibly her joints.

If it had just been her gut, her GI would have preferred to use 6MP. Unlike MTX, she had no issues with Imuran -- some mild nausea, but that was it. The risks associated with Imuran scared me more than MTX but we didn't have much of a choice.

 

[crohnsinct]

I posted a video on Mtx a bit ago. Basically the new research coming out shows it is just as effective at managing Crohn's as the thiopurines and at helping keep biologic antibodies at bay. Our Gi is also not using the thiopurines anymore for girls or boys.

I am with Maya...thiopurines scare me the most...mtx could screw with liver so for us that is a big issue but absent liver disease I would be fine with it. It does have the added benefit of dealing with joint and skin issues.