Switching from Imuran to Methotrexate

[JLOptimistic]

Hi,

My soon to be 12 yr old son was diagnosed with UC and after running through the 5-ASA's with no luck, he ended up doing a round of steroids and has now been on Imuran 100mg for just over 6 months and is doing really well(knock on wood). No bathroom issues, going to school everyday and has even started doing sports again.

Based on my understanding, the Imuran/Azathioprine has a higher likelihood of causing cancer(especially in males) than Methotrexate, which I believe is considered a similar level of medication to Imuran.

My question is whether to leave well enough alone and continue with the Imuran until we're forced to switch medications as it's working so well right now and accept the increased cancer risks or to risk switching to Methotrexate that may or may not keep him in remission but it's a safer drug? Will most doctors even "allow" you to switch if the current medication is working and my debate is moot?

Thanks!

 

[Maya142]

It depends on the GI honestly.

Our GI prefers using MTX because the cancer risks are lower. My daughter was unable to tolerate MTX (though that is uncommon - her older sister is on MTX no issues) so we had her to put her on Imuran, and I have to admit it made me more worried to have her on Imuran.

I would just talk to your GI about your concerns. I'm not sure there is a "right" answer - you have to decide whether you're prepared to take that risk.

Some GIs absolutely refuse to use Imuran/6MP for teenage boys now, but it sounds like your GI is ok with it.

 

[JLOptimistic]

Thanks Maya142.

L had his GI appointment today. Spoke with her about the MTX and she said that because he has UC rather than Crohn's, the MTX tends to be less effective than the AZA.

We did discover that he's gained 2 inches in last 6 months but his weight is lagging a bit. All his blood work is normal except for his ESR which has been on and off high. Normal a couple of times but last three were 18, 15 and 13(normal is 0-10). She wants to do a Fecal Calprocetin to try to determine if there's inflammation or not. Based on those results, we may be looking at either a round of steriods(she wants to try Cortiment, apparently doesn't have the side effects of Prednisone, but will depend on whether I can get coverage on it or not)and/or an endoscopy/colonoscopy and/or Remicade.

Basically, I'm just waiting to get the go ahead that they've gotten approval for the Fecal test and then take it from there. A little disheartening as he's been back to school, playing baseball, feeling fine and I was kind of expecting that this would be a "all good, see you next time" appointment.

 

[Maya142]

Has he had any viruses recently? A cold or tummy bug? Things like that can make ESR go up.

A Fecal Calprotectin is a good idea.

Hang in there - it is very disheartening to hear there may be inflammation when you think everything is going well. But the good news is that your GI is very careful and is making sure that everything is ok.

There are some parents here with completely asymptomatic kiddos -- some of them have had kiddos with IBD that is severe enough to require surgery. So no symptoms (unfortunately) does not always mean everything is fine.

Interesting to hear about MTX and UC. I had never heard that before.

Good luck!!

 

[JLOptimistic]

No viruses, no bugs, nothing.

We got approval to get the Fecal Calprotectin test done, so after this weekend we'll get it sent in and find out what's going on, good or bad.

He was chosen to go to CampGot2Go at the end of July, fingers crossed that nothing happens between now and then!

 

[Maya142]

Fingers crossed - hope you hear back soon and he's well enough to go to camp!!