Starting 6MP while on Remicade...?

[ravensfan88]

So, my GI was very concerned because my Crohn's is attacking my liver and also causing severe malnutrition and malabsorption. I weighed around 140lbs 3-4months ago and the CD has caused me to drop to around 100 lbs and I can't gain weight despite the fact that my appetite is very good.

I saw him earlier today and he is scheduling me to be admitted to the hospital for TPN (Total Parenteral Nutrition) to try and help with my nutritional/weight issues. He also mentioned thinking of starting me on 6MP (along with all of my current medication, including Remicade) but expressed he wants a second opinion because of the severe risk factors of 6MP (including starting it while on something like Remicade).

Anyway, I'm just looking for some information or opinions from anyone who knows more about this than I do...

Any contribution to this thread is helpful to me. Thanks in advance.

 

[Manzyb]

I believe that 6MP/Imuran and Remicade is a pretty common treatment combo. I never took them together b/c I didn't tolerate the 6MP, but I am sure there are other people around here who have experience with this!

 

[ravensfan88]

My GI had mentioned the risk of lymphoma, but I've been reading that other GI's have mentioned the risk being very small (though still there, which is good to know). At first my Crohn's didn't look as severe until blood work showed the increased Alkaline Phosphate in my liver which lead to a liver biopsy and of course my malnutrition and malabsorption which now leads me to get TPN (Total Parenteral Nutrition) as well as a new medication for my liver.

Another thing that concerns me is that he mentioned Imuran by name (also calling it 6-MP) and I'm reading that some people have had a really rough time dealing with the Azathioprine and had to switch to a different 6-MP medication. Anyone have an opinion on that? I just want to get in remission!

 

[David]

I've posted some data from studies from a book I'm reading here that contains a lot of info regarding 6-MP/Azathioprine/Imuran in combination with Remicade (Infliximab).

 

[PaulsPain]

I started with Azathioprine for 9 months and then added Remicade. I have now been on that combo since last August.

Make sure you stay on top of blood test if you go on aza or 6-MP. My WBC still yo-yo's around 4. So they have me on a 2 month draw verses a 3 month. I am taking 100 mg a day - that is all I can take without sending my WBC to low. When first start out they should be drawing blood a frequently to see how you are reacting. I also had the TPMT Enzyme test before starting.

Aza gave me some hardcore nausea and fatigue. Splitting the dose helped. I still have fatigue and was told it is just the nature of these meds.

I was told that they start with Aza first because it is easier to dose. But some people have less side effects on 6-MP. They told me I could try 6-MP if the nausea didn't improve or couldn't handle it anymore. Azathioprine is metabolized into 6-MP.

My understanding is the Aza helps the Remicade work better since it reduces my immune reaction/response to the Remicade itself. At least that is what I have asked both my GI and the GI's PA. They both always say yes.... I have also read that the combo has been shown to achieve remission at a higher rate verses either of the drugs by themselves.

I am still a little nervous about the very rare deadly cancer (HSTCL) that has developed in young adult males on this combo. Reading the FDA warning it is still unclear what "young" is.

I hope you find some relief. I was pretty miserable with peri-anal disease - large chronic fissures, fistula with seton, abscess, etc. The Remicade/Aza combo has made me feel almost "normal" - haven't felt like this in 7 years.....

 

[ravensfan88]

I've posted some data from studies from a book I'm reading here that contains a lot of info regarding 6-MP/Azathioprine/Imuran in combination with Remicade (Infliximab).

From what I gather, there is no mention of starting the 6-MP treatment after already being on Remicade. Is this not at all common? I've already had 3 infusions of Remicade and would hate to have missed a better opportunity for remission by not having the 6-MP incorporated until after Remicade.

 

[David]

From what I've read, it's not as common, no, but I don't know the numbers. Usually they'll try the immunosuppressive first or in combination. I can't find any studies with Infliximab before 6-MP or AZA, sorry.

To answer your other question above:

Imuran = Azathioprine
6-MP = It's own drug AND what Imuran/Azathioprine are broken down into once it's in the body.

I have yet to figure out why they use Imuran/Azathioprine instead of 6-MP considering they turn into 6-MP in the body and there is data supporting 6-MP being tolerated better. I'm sure there's a reason I just haven't found it yet.

 

[Manzyb]

I don't think it is rare at all. I know my old GI doc had talked to me about starting Imuran while I was already on Remicade, he thought it would help the remicade work better, but at that time he didn't know that I previously couldn't tolerate the imuran.

 

[MS LOLO]

Hello,
this post caught my attention because I was put on 6mp and I was still getting sick and I too lost a lot of weight. My GI dr. switched me to Remicade and I have been feeling better. I think it is good ur DR wants a second opinion because it does not seem like you should have to be on both of those medications at once. Shouldn't they stop your Remicade if they want to give the 6mp a try? I hope it goes well for you, please keep me posted on your outcome.

feel free to contact me with any questions or just to talk.
Ms LOLO

 

[David]

MS LOLO, there's data showcasing that a combination of 6-MP and Remicade can be very beneficial for those who tolerate it (see the link I provided above).

I'm sorry you weren't able to tolerate 6-MP That's great that the Remicade is helping though!

 

[ravensfan88]

THanks for all the great responses guys. I'll update this post when I get an appointment with the doctor I'm being referred to and let you know what's going on.