Which immunosuppresant

[old_motters]

I have an appointment with a Gi on 8-Mar. I am pretty sure he is going to offer me an immunosuppresant as my crohns is mild but becoming moderate. Is there are generally preferred one out there i can ask for. I am leaning towards Imuran.

I am on 30mg of pred at the moment and taking 6 loperamide a day but i am still getting diarrhea 2-3 times a day. I am hoping the immunosuppresants will help along with questran.

 

[Ian_H]

I have been on imuran for around 4 years and it has helped me significantly. It is one of the first immunosupressants GIs seem to go to. Its a common one.

 

[ronroush7]

I am on Imuran for several years now.

 

[Scipio]

What is your age and sex? It matters in terms of your risk of developing cancer from the Imuran treatment.

The risk for cancer from azathioprine (or 6mp) comes in two main forms. Both are age related but in opposite directions:

1. Young males are at particular risk for hepatosplenic T-Cell lymphoma, a very aggressive and usually fatal form of lymphoma. This cancer most often develops while on aza therapy in conjunction with infection by the Epstein-Barr Virus (EBV). Due to this risk many docs will not prescribe aza for young males, particularly if they have not previously had an EBV infection. The risk is small, but given the deadly outcome of losing that bet, the risk is still too high.

2. Older patients of either sex are at increased risk of regular lymphoma (usually B-cell follicular lymphoma) when on aza therapy. Some docs caution against prescribing aza in patients older than 50 and especially if they are over 60. For these older patients it becomes an exercise in balancing risk vs. benefit. For patients with mild Crohn's the cancer risk is probably not worth it. Those mild disease patients can be managed with other therapies. But for patients with moderate to severe Crohn's with risk of fistulas, strictures, etc. the small but increased cancer risk is probably worth it. The benefit of aza in controlling the severe Crohn's outweighs the small risk of lymphoma.

So if you are a young male or an older person of either sex Imuran.6mp may not be the best choice for you. It's a judgment call by you and your GI.

 

[old_motters]

I am 40 and male. I didn't know there was a cancer risk from Imuran.

Methotrexate is an option but i have heard tale of people getting eye problems with it.

 

[Scipio]

A male at age 40 is probably at very low risk for lymphoma, so Imuran may well be a good choice for you. Methotrexate is an alternative, but if it were me I'd probably do the Imuran now and save the methotrexate for a future decade when the cancer risk starts to increase.

As always, this is decision for you to make in consultation with your doctor.

 

[old_motters]

A male at age 40 is probably at very low risk for lymphoma, so Imuran may well be a good choice for you. Methotrexate is an alternative, but if it were me I'd probably do the Imuran now and save the methotrexate for a future decade when the cancer risk starts to increase.

As always, this is decision for you to make in consultation with your doctor.

Thank you. I think i know now what i am going to do assuming the GI will let me.

I have 7 weeks to wait for an appointment. Its only just hit me what a shitty disease this is, i will have to live with explosive diarrhoea for at least that long. The only saving grace is i only get discomfort when i poop.

 

[Scipio]

Unfortunately, you may have to suffer the diarrhea a little longer than that, because Imuran is rather slow-acting. It often takes several weeks before the benefit really kicks in.

 

[Shazc]

If you want something fast acting try infliximab if you can get it. It's a biologic tnf blocker.i took azathioprine from 18-35 I had 2 great years just with pentasa then it went wrong so I've just started infliximab as the steroids weren't really working. It only hit me recently too what a terrible disease this is . I'm scared stiff of cancer so I think about surgery but that sounds awful too and they can't put your colon back if you don't like having a bag or j pouch!!

 

[Eridon2002]

My GI wants to put me on Imuran. I mentioned the increase in skin cancer with Imuran since I have very fair skin. Her response was wear a hat! :ywow: That doesn't help with all the damage that I have already incurred from the sun!

 

[old_motters]

If you want something fast acting try infliximab if you can get it. It's a biologic tnf blocker.i took azathioprine from 18-35 I had 2 great years just with pentasa then it went wrong so I've just started infliximab as the steroids weren't really working. It only hit me recently too what a terrible disease this is . I'm scared stiff of cancer so I think about surgery but that sounds awful too and they can't put your colon back if you don't like having a bag or j pouch!!

I think I'll save remicade for when i really need it. Good thought though.

 

[old_motters]

Update - the GI did not think I am in the middle of a flare after all. He thinks my diarhea is bile reaching my colon and irritating it. The part of my intestine that absorbs the bile is missing after my hemicolectomy. I have been prescribed Questran to help with the bile and am now tapering off the pared thank goodness!

I was also told to avoid milk. Weird.

 

[ronroush7]

Are you lactose intolerant?

 

[Crohn's gal since 1989]

My GI wants to put me on Imuran. I mentioned the increase in skin cancer with Imuran since I have very fair skin. Her response was wear a hat! :ywow: That doesn't help with all the damage that I have already incurred from the sun!

I have very fair skin too and was on Imuran for years. As long as you are conscientious about sun screen you will be fine. I work a job which keeps me outside a minimum of 2 hours each day with no ill effects.:wink:

 

[Crohn's gal since 1989]

Update - the GI did not think I am in the middle of a flare after all. He thinks my diarhea is bile reaching my colon and irritating it. The part of my intestine that absorbs the bile is missing after my hemicolectomy. I have been prescribed Questran to help with the bile and am now tapering off the pared thank goodness!

I was also told to avoid milk. Weird.

Crohn's causes a lot of folks to become lactose intolerant, I love dairy, so I drink lactose free milk but still eat cheese. Questran helped me a lot post surgery, definitely worth a try!:dusty:

 

[ronroush7]

I drink almond milk .