Methotrexate or 6-MP?

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Chuck2008

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Dec 22, 2008
Messages
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I have to make up my mind soon between 6-MP and methotrexate, to help me get off prednisone after a full year (currently at 11mg/day). My concerns with 6-MP are the increased risk of cancer and daily fatigue (judging by messages on this forum). My concerns with Methotrexate are the inconvenience of weekly needles and a day of nausea/fatique.

My symptoms are relatively mild. No diarhea or discomfort currently, just the occasional blood from presumably having an inflamed colon. Symptoms will get worse when I continue tapering prednisone though.

Which of these drugs tend to be more effective for long term remission? Which have more side effects? Do I need to get a liver biopsy if I'm on methotrexate? That doesn't sound too appealing. In short, if you hadn't taken either of these drugs before and had my symptoms, which would you choose next?

Any advice appreciated. I've been puzzling over this decision for a long time now and can't put it off any longer, much as I'd like to :(
 
I take 6MP. I'm waiting to hear back from blood tests to make sure I'm accepting it all right. Every month or so starting out with the 6MP you need to have blood work done. Its a pretty powerful drug. It'll take a couple months to build up in your system to see it working. I'm hoping it does the job for me.

I haven't taken the other one. Remember its an immuno-suppressor drug. You're bound to have a little fatigue. I think our fatigue is just what comes with having Crohn's.
 
I went on 6mp in March after a long period of pred. Had same cancer concerns, but after much research convinced myself the risks aren't that great so I went for it.

It's keeping me in remission. I found I couldn't handle >50mg (liver tests showed my body rejects it) but I'm doing fine on the lower dosage.

I got fatigue initially - not sure if it was more the pred taper or the 6mp. I have days of fatigue but it's not horrible. I just feel lazy.

Long story short, I don't know methotrexate but I find 6mp to be a good drug for me.
 
I have been on both. 6MP gave me the best scope ever - completely clear, but I couldn't tolerate the fatigue/symptoms that it gave me. I felt like I was flaring (diarrhea and fatigue, but no pain) even though I wasn't.

MTX didn't do a whole lot for me as far as I could tell, and so they took me off of it. I was taking it in conjunction with Remicade, so I just kept taking the Remicade. That doesn't mean it wouldn't work well for you though. I had nausea the day of the shot and fatigue the next day - so not as long as 6MP.

Hope that helps - good luck with your decision.

Oh - and no liver biopsy that I know of - just blood tests.......
 
Who's told you need a liver biopsy if you take methotrexate? (MTX) You can also take it as tablets if you dont like the idea of injections, although it may have less side effects if you inject. However...

I would initially try 6MP, or it's pro-drug azathioprine, because if you tolerate it, it is a pretty safe and affective drug. Methotrexate is further along on the risk vs benefit scale. And when I came off it my GI admitted that it does seem to drop patients brain function by about 10 - 15%. He didn't tell me that beforehand! - and being a software engineer by trade that really is unacceptable.

I've been on all 3, aza, 6-mp and mtx. Lets just say I'm now on Humira! :)
 
Hi,

Thanks for the replies. So whats the big difference between 6-MP and azathioprine in terms of effectiveness? I have read 6-MP is better tolerated. I'm wondering why anyone would take azathioprine instead of 6-MP?
 
Mercapturine did me in fast, and metho gave me migrains or sick headaches, but my Crohns was good for a time but couldnt stand the headaches. Everyone has different reactions. Metho was by needle and therefore not has hard on the gut, 6mp is a tablet which has a greater risks even if you are a big water drinker. That is just my opinion of how it affected me. I would think Meth is quicker to heal. My 2 cents.
 
There are a number of reasons to prefer aza over 6mp: the biggest is probably that it is cheaper! The general reasons to use Aza, a pro-drug, rather than it's metabolite, 6-mp in this case, directly is that the pro-drug is usually selected to be less generally toxic, better absorbed or have greater bioavailability/etc. Some drugs are selected because they are metabolised into the active substance at or near the target site so reducing side effects.

Some people find that the other metabolite of aza makes them nauseas, so tolerate 6-mp better. Unfortunately I wasn't able to tolerate the 6-mp - it made me go into the 'poison' response - ie throw-up spectacularly, so couldn't take either of them.

When we got to methotrexate my GP described the risk vs benefit of the 3 drugs something like: Aza is pretty good and well known, if it does cause you harm it's usually reversable on stopping it. Same for 6-mp. Methotrexate is probably more effective, but if it takes a dislike to you the effects can be permanent.

Wikipedia has some good pages on these, and pro-drugs in general.
 
Im on 6-mp at the moment I thought I was having issues with it over xmas but now think it could have been the antiboitics I was on. I have noticed Im a lot more tired but I think this is also starting to improve Im going into my 4th week on it. I was original on Imuran (aza) but had a reaction to it so my GI put me on 6-mp which apparently has less side effects and is processed differently within the body?? My GI also told me they don't generally give you 6-mp first up as its more expensive then Imuran.. nice hey.

Im sorry I haven't tried the other drug you mentioned, hopefully no matter which one you choose to suit you it will help you get into remission. I have my fingers cross for both you and me!! :)
 
Hi,

I found the best article ever on the safety of 6-MP and other immunomodulators and Crohns (relating to their increased risk of Lymphoma). It really put my mind at ease after 3 months of studying and weighing my options. I'm going to start on 6-MP in a couple weeks. Just need to ride the prednisone energy wave a little longer to get some work done first :)

If anyone wants to discuss the results I'm here!

Here is the article: http://www.clinicaladvances.com/article_pdfs/gh-article-200911-siegel.pdf
 
beth said:
When we got to methotrexate my GP described the risk vs benefit of the 3 drugs something like: Aza is pretty good and well known, if it does cause you harm it's usually reversable on stopping it. Same for 6-mp. Methotrexate is probably more effective, but if it takes a dislike to you the effects can be permanent.
Click to expand...

I guess all things being equal I might as well go with a convenient daily pill rather than stabbing myself with a needle :). Thanks for the info!
 
Chuck2008 said:
Hi,

I found the best article ever on the safety of 6-MP and other immunomodulators and Crohns (relating to their increased risk of Lymphoma). It really put my mind at ease after 3 months of studying and weighing my options. I'm going to start on 6-MP in a couple weeks. Just need to ride the prednisone energy wave a little longer to get some work done first :)

If anyone wants to discuss the results I'm here!

Here is the article: http://www.clinicaladvances.com/article_pdfs/gh-article-200911-siegel.pdf
Click to expand...
Hey - this guy spoke at the IBD conference I went to this past summer. He was *excellent* and I still wish I could get my hands on his slides to show you guys all the information he presented. His section was "Estimating the Risk of IBD Therapies". It was very informative. Good find Chuck!
 
No liver biopsies are necessary on these drugs, but getting full liver panels done in your bloodwork is. Usually is a bloodtest every week for a month, then every other week for a month and then monthly from there on out.
 
Hi all - I am on 100mg 6-mp a day and I am bruising SO easily. I know it is one of the possible side effects, just wondering if any of you are experiencing this too? I have been on it for almost 3 months now, and I noticed the bruises appearing all over about 3 weeks ago.
 
GirlFriday said:
Hi all - I am on 100mg 6-mp a day and I am bruising SO easily. I know it is one of the possible side effects, just wondering if any of you are experiencing this too? I have been on it for almost 3 months now, and I noticed the bruises appearing all over about 3 weeks ago.
Click to expand...

When I was on 6-MP, I did bruise easily. I was only on it for a short time because my body couldn't tolerate it.

I still bruise easily but I blame that on blood thinners.:ybatty:
 

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