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Vaccinations before starting 6-MP

Hi guys,

I have just finished a 3 month prednisolone taper which has put my Crohn's in symptomatic remission. I need to start a maintenance therapy - I tried azathioprine 4 weeks ago but after 3 weeks of severe vomitting/nausea/diarrhea and raised liver enzymes my consultant agreed I should stop. They now want me to start 6-MP however my GP will not prescribe this until I receive a pneumococcal vaccine but the GP has no supply of this so have asked the consultant/hospital to source it - I haven't heard from them yet about this (it has only been a week).

For the last week I have started getting some Crohn's-like abonminal pain creeping back in and I am very worried about my symptoms coming back now that I have finished the steroids.

I am aware the 6-MP is not capable of inducing Crohn's remission only maintaining it so I want to start the 6-MP asap while my symptoms are under control from the steroids - is it normal to delay 6-MP to get up to date on vaccinations? I don't understand why I was allowed to start azathioprine without the vaccine but not 6-MP considering they are so closely related and have the same mechanism of action.

I know in the ideal world I would receive vaccinations while I am not immunosuppressed but if my Crohn's flares in the meantime I will need another course of steroids which I really really want to avoid!

My question is have you delayed starting 6-MP until you had all the required vaccinations? And if so how long was the delay?

Also did you get a HepB vaccine before starting?

Thanks in advance!

my little penguin

Staff member
Aza and 6-mp are sister drugs
My kiddo was like you but failed 6-mp fir raised liver enzymes
We were told he would not be able to try Imuran (aza) since it would have the same effect
They switched to mtx instead
Didn’t work -needed remicade but at least we tried

as far as vaccines in kids they want them up to date before they start biologics
But nothing on immunosuppressants

we just time the vaccines to be given one week after his mtx and then hold for one week
We do not hold his Stelara or other biologic

he was dx at 7 so has had most of the normal vaccines prior to starting but not all the teenage ones


Well-known member
San Diego
The rule of thumb for vaccines in general is that it takes about two weeks for your immune system to fully respond. So one timing strategy you could consider in order to get the COVID vaccine and yet minimize the time you delay the 6-MP would be to get the Johnson & Johnson COVID vaccine, since it requires only one dose. Then you could start the 6-MP in as little as two weeks later - hopefully before you fell out of remission for due to lack of a Crphn's maintenance medication.
Thanks for the replies! It is interesting to see how vaccinations are managed in different cases.

Also just to clarify it is just the pneumococcal (pneumonia) vaccine I am waiting on, not the covid vaccine. On that note I have had 2 doses of the covid Pfizer vaccine although I received the second dose while on 35 mg prednisolone so my IBD nurse told me it's possible I had a weak immune response (but was very adamant that I should not delay starting prednisolone to get the vaccine while not immunosupressed as being in a crohn's flare puts you at a bigger risk of serious covid so pred asap to sort out the flare was preferrable). Buttt that does mean I am eligible for a 3rd additional dose when the UK starts giving out 3rd doses to the immunocompromised population :)