6MP

I can't comment on your disease state, as I do not have obstructing disease. However, I am one of many on this board who have been on 6mp. I use it alone (50mg daily) and have for about six years now, with very good results -- only the occasional miniflare of a day or two. At my last colonoscopy in December the GI had to look and hunt to find any sign of disease activity in my colon; he finally located a small half-healed ulcer near the ileocecal valve, although we sure I do have some mild inflammation up in the small bowel. Overall my 6mp experience has been excellent, and while the lymphoma factor is always there, I for one believe that the same or greater cancer risk would stem from uncontrolled active Crohns inflammation. As for gradual onset of therapuetic efects, it's just one factor about 6mp we have to accept. Many GIs will start a patient on 6mp or its sister drug Imuran and keep them on pred or some other medication for a few months until the new drug hits its stride.

I also have stricturing/obstructing CD. 6mp was my wonder drug. It put me in remission w/in months and kept me there for years (still there). I never had any side effects from it (3+ yrs). I stopped the med to have a baby and am still in remission.

My GI also wanted to avoid the remicade/humira drugs. The big concern was that my main stricture is so severe I could not afford anymore scar tissue that would result from the fast healing those drugs produce. I've never been too worried about the lymphoma thing w/ 6mp. It's a risk with the other drugs too (FDA just began looking at those in kids due to Lymphoma risks). Plus, on 6mp we get much lower doses than transplant patients who have been studied for a while.

Good luck if you try it. Make sure to stay on top of your bloodwork.

I was on 6MP for years, I can't even remember how long (Maybe 5 or 6?) I even took it throughout my first pregnancy and had no side affects and my son came out just fine. It's definitely worth a shot. I finally had to go off of it for breast-feeding.

Good luck to you. I understand it's always scary starting a new medication.

As always discuss your personal cancer risks and family medical history with your GI doctor.

As for my personal experience with 6MP over the last 25 years: I can take it or leave it. I have ADHD as a complicating factor so I can end up forgetting to take it for months at a crack which clearly doesn't help. I have been on it for years at a time -- with minimal numbers and lengths of lapses of memory -- where it seems to help quite nicely and other times where I still developed strictures or fistulas which eventually required surgery. I've also been in remission for years at a time with no stricturing while on no Meds... Since the last surgery (in 2005) I've never really stayed fully in or out of remission so my GI Dr bumped the dose of 6MP to the max mg/kg, and that seems to have helped.

For the down side. I tend to get sick more often while on 6MP, nothing serious or life threatening. Also, It elevates my liver functions, but never outside of the normal range; but it is enough for me to avoid alcohol... no more than 3-4 drinks PER YEAR. (I had a spike in liver function a couple years back...)

I also have IBS on top of Crohn's which confounds my ability to say *for sure* if I'm in a Crohn's flare. I just contact my Dr if I suspect I may be Crohn's; he orders blood work which is usually pretty much dead-on for clearling up the question of IBS vs Crohn's. (Sed rate, white count and CRP are elevated when in a flare...)

From all the great comments I've seen about 6MP over the years, it clearly works well for most people. So the important question is "which of the two is the greater risk: " Death during surgery or contracting lymphoma?"

From stat's I've seen dying during surgery is more likely than contracting lymphoma from 6MP. To boot, Lymphoma is treatable, and not a death-sentence. Crohn's patients on 6MP are monitored more closely than the average person for this, which means if you contract it, and you're keeping your appointments, it's likely to be caught sooner than in the general population, which increases the odds of survival a lot.

FYI From the literature I've read the cancer risk with 6MP tends to be 1 in 1500 or less (I think). Across all populations, you have a roughly 1%-5% of dying everytime your belly is split open for a resection. I've not found any stats specifically addressing mortality rates for resections on Crohn's patient. (That would be a more accurate comparison...)

I hope that helps.

Thanks Eddie. I've struggled with the same question a lot in my life. So a while back I finally bit the bullet and started looking up the statistics... I realized I was neither being an idiot by worrying about it, nor being smart by refusing to use 6MP. (Which I had for a number of years...) So yeah I learned all that the hard way. I'm just glad college was the period of little to no meds+remission. (I was the typical college student...)