What to try next if mesalazine doesn't work?

[nitty]

Hi everyone!

I'm still new to all this, but need some opinions for future reference.

After being diagnosed (by colonoscopy) with mild Crohn's in my colon I've been on oral Pentasa and Salofalk suppositories, with initially a good response, but then it's grumbled away pretty painlessly and without the bleeding stopping fully. I spoke to my IBD nurse today who has said I can try a different preparation of oral mesalazine (Salofalk, which apparently may release a bit further down in the gut than Pentasa) and a higher dose of suppository.

If this doesn't work, she said I may have to try azathioprine or a short blast of steroids.


Now for the questions!

:confused2:Has anyone had improvement from just changing which form of mesalazine they used?

:confused2:Which is the better (or less bad!) option - Azathioprine or steroids? Do they try you on one before the other?

:confused2:If trying steroids, have people had better experiences with Budesonide rather than Prednisolone (effectiveness/side effects)?

:confused2:Azathioprine - how many people use this without problems? The nature of forums is that you tend to hear more from people who are having difficulties and so perhaps my view is a bit skewed towards the negative.


I may be jumping the gun a bit here, but I just want to as well informed as possible if the time comes...!

(By the way, thanks for the fab info pieces about the different drugs - really helpful:thumright



Nitty XX

 

[Rebecca85]

1) yes, some people just get on better with one type than another.
2) steroids are better in an emergency, as it acts quicker, but azathioprine is better for long term.
3) entocort releases in the terminal ileum (end of small intestine) so may not work if your main problems are in your colon. It also takes longer to have an effect than pred. But on the plus side, if it's suitable it has less side effects.
4) I am an azathioprine success story. Yes I had a few teething problems, but that's all they were! There are others on here who have success with aza. Not sure of the percentages though!

 

[Astra]

Hiya nitty

I've been on Azathioprine but was allergic to it, so came off it.
I've been on Pred, but I had to, I was in hospital with a blockage and infection.
Depending on where your IBD is, Budesonide might be a good start, I have been on this many times too, my Crohn's is in the terminal ileum so this med is ideal. It's non systemic, unlike Pred, only goes to the small intestine and the start of the large.
You could try this for 3 months, 9mg for one month, then 6mg, then 3mg, with the Azathioprine to maintain, as this could take up to 12 weeks to get going.
I've never changed from Pentasa so can't help there.
good luck
xxx

 

[Artificial]

Hi there Nitty

I much prefer Budesonide to Prednisolone...although Pred did make me feel a lot better for a bit I did have a few side effects which I don't have now I'm on Budesonide.

But the side effects I did have were nothing too major - trouble sleeping, being a bit hyper etc

With the Azathioprine, unfortunately it has not really helped for me as I have a stricture and fistulas it can't sort but again I have not had any side effects at all.

Hope that helps! x

 

[nitty]

Thanks for the replies. Hopefully it won't come to that, but fore-warned is fore-armed, information is power and all that - especially when it comes to dealing with doctors (and I'm married to one!)! I start the new meds next week, as I'm away before then, so fingers crossed....