Just started imuran, remicade to follow - some questions

I am going to do combination therapy for CD ileitis, improperly diagnosed as UC for ~11 years. I'll try to bullet-point my questions and if anyone has experience or knowledge, I'd greatly appreciate it:

- I've discontinued asacol HD which I'd been taking for ~7 years. Should I notice a change?

- I am not scheduled for my first infusion for 9 days, so I am continuing my mesalamine rowasa enemas nightly in addition to the imuran...i understand this is ok, yes?

- I am taking 150mg of imuran, on day 3. So far I've noticed looser BMs but not greater frequency. Is this a common side effect? Will the side effects pass as my body adapts to the new medication?

- what should I expect when I start infusions of remicade and discontinue my rowasa enemas? I am most nervous about this, as it has helped my symptoms more than any other treatment I'd ever had and still is effective at minimizing urgency and frequency...

Overall I don't feel well, which is why I'm going full bore with combo therapy. That said, I am better symptomatically than I've been during other flares. Should I expect a step back before the combo therapy moves me two steps forward (ideally)? Is there a rule of thumb on how this all should feel?

Once again all feedback/suggestions/answers are appreciated

I don't think you'll notice a change from dropping the Asacol. That's considered outdated treatment. Unless you noticed a severe improvement when you started it.

Imuran usually takes up to 6 months to reach it's therapeautic effectiveness, so you might not notice anything from that for awhile.

Remicade is still the best treatment option we have. It's highly effective. Most that start Remicade feel it's benefits immediately. Even during the loading doses. For others it's not uncommon to take 3-4 infusions to see good results. The results from Remicade can be incredible for some. Hopefully it works out well for you.

As far as stopping the enemas, if they're working for you, you might wait until you get an idea on how your new treatment plan is working, then discontinue them.

You really don't need to do anything to prepare for your infusion. There are some minor side effects that vary per individual. They usually give you what's called premeds. Tylenol, a very mild steroid to offset these. Most go through the infusions without issue. You might feel tired for a couple of days is all.

I'm a little torn about stopping what I've been taking cold turkey, before the infusion or the Imuran has a chance to start working.

I took Asacol for over 10 years to treat misdiagnosed UC, which turns out was actually CD in my colon. It helped me feel better. I've been told that Mesalamine doesn't work for CD, so there's no need to keep using the Asacol or Rowasa. I'm definitely not stopping the latter until my first infusion.

In my GI doctor's words: "Mesalamine shouldn’t be necessary and I would like to see effect of Remicade with Imuran. You'll already be taking a lot of medication, so let’s see what we can achieve with those two agents. The incremental benefit of mesalamine enemas is very limited. I’ll continue to prescribe if you insist."

I am really kind of at a loss here. I felt like the Asacol was doing something, and the Rowasa was a relative game changer for years. If Imuran + Remicade don't start working right away, why would he suggest I stop what is? Do the two classes of drugs interact or offset each other in some ways?

I went straight to Remicade & Imuran right after a resection many years ago. My gi put all of us Remicade people on Imuran as he said it helped prevent antibodies. Some people could tell a difference after the first infusion. Be sure that you are well hydrated for your infusions, helps get a vein easier. I was also given IV Soluable Medrol & IV Benadryl to ward off any reaction. I had a reaction on the 3rd infusion that is when the steroid & Benadryl was added. They also slowed the rate of the infusion down & I never had a problem. I did this for 3 1/2 yrs.

Take some snacks & something to entertain yourself with while having your infusion. Check with your dr if you have questions about your meds. Good luck & take care.