Thiopurine, Remicade, or ...?

[whyclef]

Hi everyone, my Crohn's has recently been labeled steroid-dependent. I'm needing to take the next step in treatment as I currently cannot go below 20mg Prednisone without flaring. My IBD doctor would like me to start with 75mg Aza this week, but has also said we can do TNF treatement if I'm more comfortable with that.

I have read much about both and it seems there is a proven cancer risk with Thiopurines vs Remicade (TNFs). Also concerned about the Pancreatitis risk and side effects from Thiopurines. Any advise is welcome from those who've been on either treatment? I also welcome treatment options my doctor has not presented.

Active Inflammation appears to be confined to left side of colon and rectum based on last scope.

 

[DJW]

I'm on Aza and Remicade. Their is a cancer risk but it is very slight.

In my case the slight risk out weighed the complications I have already experienced. Your risk of cancer also increases from chronic inflammation.

 

[Robrich]

Whichever works and then stick with it
I would choose the remicade if it works you will know right away
Aza takes up to 6mos to work and for me it never did but remi worked within days and I who was also steroid dependent with fistulas was steroid free for the first time n 20 years!
Lasted for 9 great years
Good luck

 

[whyclef]

Whichever works and then stick with it

I would choose the remicade if it works you will know right away

Aza takes up to 6mos to work and for me it never did but remi worked within days and I who was also steroid dependent with fistulas was steroid free for the first time n 20 years!

Lasted for 9 great years

Good luck

Were you ever on combo therapy (Aza + Remi) or just Remicade?

 

[Justanothercp]

I'm also "steroid dependent" (even after resection). I'm on Remicade and Budesonide. I've been on both for abound decade and so far both seem fine. I struggled with purines, my blood work started getting out of whack. But everyone responds so different, I think you just need to try whatever you're most comfortable with, if it doesn't work, try the other.
Have you hade surgery? Are they discussing it? Do you have strictures?

 

[Robrich]

Were you ever on combo therapy (Aza + Remi) or just Remicade?

6mp with remi I was desperate for it to work. 6 mp never did anything for me in the past except pneumonia.
Took it for 6-8 months w remi but liver started to fail jaundice all that stuff. I just stopped taking it and within days those liver symptoms went away ifelt better and just told my GI I stopped.
It's worth a try just keep a close eye on your liver.

 

[Robrich]

Duplicate

 

[whyclef]

I'm also "steroid dependent" (even after resection). I'm on Remicade and Budesonide. I've been on both for abound decade and so far both seem fine. I struggled with purines, my blood work started getting out of whack. But everyone responds so different, I think you just need to try whatever you're most comfortable with, if it doesn't work, try the other.
Have you hade surgery? Are they discussing it? Do you have strictures?

So far no surgery or identifiable strictures... I have not started Azathioprine yet, researching Qu Crohn's Trial as an alternative and asking my IBD doctor about it before I commit to trying the purines.

 

[alex_chris]

Azathioprine/6mp mono therapy doesn't really help with inducing remission, which is the reason the AGA guidelines only recommend it if steroids work for someone and that someone IS already in remission or even achieved remission without steroids.

Which means for a steroid dependent patient (not sure how long you have been on steroids now), the clear recommendation by today's medical standards is a biologic drug, depending on the severity of the case, in combination with azathioprine/6mp (as some studies showed combination therapy has statistically better results).