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Methotrexate,Imuran or Remicade, Humira or Cimzia

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Crohn's Disease
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Posted 4/29/2009 11:07 PM (GMT 0)
Here's the deal,my doctor wants me to go on either Imuran or methotrexate as a maintenance medication.  I had a resection in February and I really want to keep this DD away as long as possible.

What do you all think is the best and safest medication out of the drugs listed: Methotrexate,Imuran or Remicade, Humira or Cimzia ?

All input and experiences will be much  appreciated.

Wolfie

 

Posted 4/30/2009 1:37 AM (GMT 0)
I would recommend you see how Imuran works with your body. Usually methotrexate is only used if you can't tolerate Imuran due to side effects. It's best to take Imuran in the evening so you avoid side effects by sleeping them off. I believe blood testing is needed slightly less frequently for Imuran than methotrexate, too. Also, methotrexate is once a week dosing, which is kinda difficult to remember (for me at least). I'd be more compliant with once a day dosing.

Stepping up to remicade would be useful if symptoms start up, as this is an expensive drug. Cimzia and Humira are usually used when/if remicade stops working. It's sort of a matter of saving the more powerful drugs for later, so there is still some 'ammunition' if things act up. Hope you only need a small dose of Imuran and you have a long remission. Eat healthy, avoid stress, and get some mild exercise and you'll do just as much for your body as taking meds.

Posted 4/30/2009 2:07 AM (GMT 0)
Did'em all except Cimzia. Methotrexate and imuran both worked for awhile, Ramicade did nothing, Humeria may have been working but the side effects were not worth it. Just my experience..I agree with camjames in that you should start with Imuran or methtrexate before stepping up to ramicade or humeria.
Posted 4/30/2009 3:34 AM (GMT 0)
Hi Wolfie,
Iwould try either the Imuran or Methotrexate before the biologics.
I have been on MTX for nearly three years and had used Imuran till it gave me acute pancreatitis, so these two drugs are not similar. Try and see which one works for you.
Good luck
Jo
Posted 4/30/2009 4:47 AM (GMT 0)

Wolfie, one of the reasons I agreed to surgery was in the hope of not having to go on these drugs, at least not for maintenance. If I do not have any more symptoms than I do now, I am hoping for something like Asacol. I know I have a lot to learn about this disease but the possible side effects of the drugs seem worse than anything I have experienced so far.

I have had no side effects from the methotrexate and would agree to that for awhile longer but then I would want to reassess how things are. I see you are on Asacol. How is that for you and does your doctor not consider that a manitenance drug?

 And how are you feeling? I watch for your posts because our situation is somwhat similar and I am getting very close to my surgery date.

Posted 4/30/2009 5:47 AM (GMT 0)
Well, I haven't tried any of these drugs yet, my doctor just gave me basically the same options and I'm going with Imuran. I'll be starting in a few days (I just got my wisdom teeth out and have to wait until they heal a bit more). Imuran just seemed less "scary" to me than all the others, I think because there were less possible side effects, plus I'd prefer pills over injections.

What are you leaning towards?
Posted 4/30/2009 6:07 AM (GMT 0)
Just a point about Asacol: these days the studies are showing less favorable results for the efficacy of Asacol in crohn's disease. They are claiming Asacol (along with Pentasa etc), are only somewhat effective for Ulcerative Colitis, but not crohn's. Probably most GI docs would prefer you on a lower dose of Imuran/methotrexate than Asacol/Pentasa, unless you have had some previous success with these aspirin derivatives.
Posted 4/30/2009 11:34 AM (GMT 0)
Thank you all for the quick replies, I really dread going on any of these but my doctor said that i need a good preventative medication.camjames your right, my doctor said the same exact thing, that it is more for the colon than the small intestine. I asked the doc, since 2001 til now has Asacol done its job. I was told that I would never require surgery. He and I both feel that Asacol was not powerful enough to keep the Crohns from getting worse.
Bammer: When is your surgery? I have not seen you on here so I thought that you had it done already. I was conerned! I really don't want to go on these meds, but if I don't want the disease to come back,I'll need some type of maintenace med.
I really wanted to go on LDN but my doctor doesn't know anything about it. I have printed out a ton of info it and am going to give it to him and hope that he will put me on it. I'm running out of Asacol so I need to make a decision soon.
I appreciate alll the replies keep them coming and i will continue to research the heck out of these drugs and hopefully find one that will suit me.

Wolfie
Posted 4/30/2009 1:45 PM (GMT 0)
Camjames I have to respectfully disagree with you about the 5ASA's. I have been on Asacol for over 4 years and it is helping me to maintain my remission. Others on this forum have found that the 5ASA's they take are helping them too. Like me, many stopped taking them thinking they weren't working only to find out that they were because they immediately flared when stopping them.

Wolfie, I would try the Imuran or 6mp first. These meds have a record of success for many people, and many have been able to stay on these meds successfully for years and years.

Good luck with your decision.

Gail *Nanners*
Posted 4/30/2009 3:11 PM (GMT 0)

Wolfie, my surgery is May 11th, get to to the colyte prep on Mother's Day.

I have read that Asacol might not be that effective but right now my only stricture and inflammation is in the colon so maybe it would work for me? Plus my crohn's has been called 'nontypical', 'the mildest case of Crohn's I've seen', etc. I still don't like to say it's mild if I am going to undergo surgery but I feel like it has been around for along time without my knowing it before it manifested into a stricture.

Previously my GI suggested Imuran if I did not opt for surgery. Then when I was leaning toward surgery he wanted to try Methotrexate by injection (because I think it work's quicker and in my case that's want we wanted to see). At the time I know I had researched the drugs and was happier he suggested that than Imuran. (Would research again if faced with that decision). But now that methotrexate does not give me any side effects I will be willing to keep on that for awhile. I took 25mg/week for four months then it was reduced to 15mg/week.

I didn't know until last year that my cousin who is a doctor has Crohn's also. He had a resection years ago and now takes MTX but mainly for his arthritis. There is something new that it is just injected under the skin, not into the muscle? He also said that he would be very leery about taking Remicade himself. Another cousin's husband has Crohn's and the wife blames Remicade for her husband developing cancer and had to have his ear removed. She will admit that there was a sore there before and thinks the Remicade had something to do with the advancement.

LDN does sound interesting but haven't researched it much, don't know if it is available in USA and Canada? Keep in touch and let us know how it goes.

Posted 4/30/2009 10:55 PM (GMT 0)
My docotr said that If I would go on Imuran that the dosage would be 50mg to start and than slowly work up to 100mg and than 150mg. I only weigh about 165# is 150mg going to be to much?
If I was to go on Methotrexate, any idea what the dosage might be? That is th eone question that I forgot to ask my doctor.
Nanners, I too have read that Asacol may not be as effective in the small intestine and that it is more for Colitis. I do believe that you are right though that it does work and if I were to stop that Crohns would definetly come back with a vengence.
My doctor said that asacol is a base line drug and Imuran and the biologis are all above it. I'm so confused as to what to do, a co-worker said that she would roll the dice with the asacol and see what happens, rather than go with Imuran or Metho with more severe side effects. It's a tough call, I know my body does fine with Asacol as I've been taking it since 2001, I just don't know about the others.
The big question is do I roll the dice?

Thank you all for the great advice.

Confused Crohnnie..
Posted 5/1/2009 12:29 AM (GMT 0)
Wolfie if you are doing well on just the Asacol I would give it a chance. The Asacol is working well for my Crohns, which by the way is/was located in the terminal ileum. I do not have colitis.... I have also been taking it since my last resection. My doctor and I have discussed meds and if the Asacol should ever stop working for me, my next step will be 6mp (sister med to Imuran). I have told him I agree with that decision. Good luck with whatever you decide.

Hugs
Gail *Nanners*
Posted 5/1/2009 1:00 AM (GMT 0)

Wolfie40 said...
My docotr said that If I would go on Imuran that the dosage would be 50mg to start and than slowly work up to 100mg and than 150mg. I only weigh about 165# is 150mg going to be to much?
If I was to go on Methotrexate, any idea what the dosage might be? That is th eone question that I forgot to ask my doctor.
Nanners, I too have read that Asacol may not be as effective in the small intestine and that it is more for Colitis. I do believe that you are right though that it does work and if I were to stop that Crohns would definetly come back with a vengence.
My doctor said that asacol is a base line drug and Imuran and the biologis are all above it. I'm so confused as to what to do, a co-worker said that she would roll the dice with the asacol and see what happens, rather than go with Imuran or Metho with more severe side effects. It's a tough call, I know my body does fine with Asacol as I've been taking it since 2001, I just don't know about the others.
The big question is do I roll the dice?

Thank you all for the great advice.

Confused Crohnnie..

No it's not too much. Max dosage of imuran is 2.5 mg/kg so that would be about 200 for you. Good luck!
Posted 5/1/2009 3:23 AM (GMT 0)
Nanners, how do you know if it is not working, especially after a resection when all the disease area has been removed.
Posted 5/1/2009 2:11 PM (GMT 0)
I am on 100 mg of Imuran and I weigh 95 lbs, so your dose of 150 is good. I was nervous going on this med, and my GI realized that, so I go for biweekly blood work to make sure my body is handling it well. Sure, it costs a bit of extra money, but to me it is worth the peace of mind. Also, he ran a promethius test to see if my body can properly metabolize Imuran or 6MP and the test results showed that I can (so far, they're right). I would recommend getting that blood work done first so you don't have any surprise initial reactions.

I chose Imuran over 6MP b/c it supposedly has less side effects. So far, the only side effect from Imuran (besides finally feeling much better!) is hair loss. It's not major hair loss, but my hair is definitely thinner. At first, I was very tired when on it - but that could've been b/c I was in a major flare.

I hope you find a med that works for you!
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