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Remidcade v. Imuran for next step?

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Crohn's Disease
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Posted 2/20/2008 8:56 PM (GMT 0)
Hi!  We met with a new GI guy yesterday.  DH is not responding to any treatments (increasingly higher doses of Pentasa; looooooong courses of Flagyl and Cipro; and Prednisone) so far.  His quality of life is almost zero, it has affected everyone in our family.  He feels badly that we can't do the things we used to, but I say we will survive, let's just get him feling better.

This new GI guy is much more agressive, wants us to consider Remidcade.  He started out saying Remicade, we asked what about 6-mp or Imuran.  He asked hubby if he wanted to feel better in 6 months or within a few weeks....

He gave us information on both, and a new anitbiotic (Xifaxan)to try for the fistula, which is NOT improving.  He slowed the predisone taper somewhat from the first guy's schedule, and I am more comfortable with that.

Now....should we go right for the big guns of Remicade, or try the Imuran?  DH has been dealing with all these compounding issues for nearly one full year now; has had his Crohn's diagnosis since November 2007, but all the troubles began just about 1 year ago.  He is sick and tired of being sick and tired!  We thought we'd get better results from the prednisone, it has been a disappointment to say the least!

Any advice?  I've read up on both of these; and really, if Remicade can help him faster, I am inclined to go with Remicade.  But thought I would get some imput from here first.

--newcrohn'swife

Posted 2/20/2008 9:02 PM (GMT 0)
Sorry hubby is not having any luck with prednisone. I currently take both Remicade and Imuran. I did start with the Cade and then added the Imuran when it needed a boost to last the whole 8 weeks. I would say go with the Cade first and do not worry if you have to add the Imuran later. Sometimes it takes a combination to get results.

Good luck.
Posted 2/20/2008 9:05 PM (GMT 0)
Hi, I am on Remicade and Imuran for almost 5 years now. These 2 drugs work very well together. I am enjoying being in remission. Its going to be up to both of you on what he decides.
Posted 2/20/2008 11:07 PM (GMT 0)
Thanks for posting this question, I was supposed to start Imuran this week and was wondering how I was going to hold up if it took months for me to start feeling better, and if I should ask for a medication that might work sooner.  I'm already terribly exhausted from being flared, and miss a couple hours of work every day, and am worried about my job even though I forseeably have enough sick/vacation time to hold out for a while.  It did not occur to me that I could do Remicade with Imuran so that I can get better sooner, I think I will ask about that.

Both of the medicines are a bit scary sounding, but losing my job and insurance is scarier since I have no family or husband to help me live if that happens.  My doctor is pretty conservative and wants to make sure I get sick (again) right away (again) when we taper the prednisone I'm on, but I'm gonna call him tomorrow and ask to get the Imuran started anyways.  It's nice to know that I have the option to also take Remicade at the same time if the Imuran takes a long time to work.  I'd rather be able to tell my boss I'm sick from my medicines if I have bad side effects than sit around and tell him I'm sick and it'll be a few months before my medicine might work and I'm not a "bad employee" anymore. sad

Posted 2/21/2008 3:06 AM (GMT 0)
I was on Remicade 3 1/2 yrs, my GI puts all Remicade peeps on Imuran, it is suppose to enhance the effects of the Remicade. But, It takes a min of three months for the Imuran to start working. I went straight to Remicade because I could not tolerate steroids. REmicade lost its punch after being on it as long as I was. Otherwise, I would still be doing it. It really did help me. Imuran is a maintenance medication with my gi also.
Susie
Posted 2/21/2008 5:46 AM (GMT 0)
Hi newcrohnswife...I was on Remicade for 3 yrs. &, while I had allergic reactions to the drug, it did help alot. I'm curious as my gastroenterologist insisted that I first start on an immunosuppressant (6-Mercaptopurine) in order for the Remicade to work properly. I also had to use Prednisone during the week of the infusion & was given Ativan, Benadryl, Tylenol & Zantac on the day of the infusion. Here's the downside...I was diagnosed w/ an extemely rare eye cancer, in 2005 (Conjunctival Malignant Melanoma). The doctors immediately stopped the 6-MP & Remicade, fearing that these (namely, Remicade) may have either caused or contibuted to the cancer. A friend's mother was considering Remicade for her Rheumatoid Arthritis but her doctor refused to put her on it due to the serious side-effects being reported. I was desperate & can't say that I would've changed my decision to use Remicade, had I known that I'd end up w/ this cancer (again, they don't have proof that Remicade was the cause); however, I would consider Humira in place of Remicade. Humira contains human protein while Remicade contains mouse protein (probably the cause of the allergic reactions which I experienced during the entire 3 yrs.). I'm not trying to scare you but believe that people should consider all options. I went through all of that & still ended up w/ an ileostomy. Lastly, I was also so sick & in so much pain when I started the Remicade...it did help to improve my health, at that time. You just need to discuss & weigh all of your options. Wishing you better health... tongue
Posted 2/21/2008 4:32 PM (GMT 0)

Newcrohnswife, I'm so sorry to hear that the steroids (etc.) haven't helped at all. I'm also a bit surprised; from what I've read, only the most severe cases of crohn's don't respond to steroids. *Most* cases get at least some improvement, but from what I gather from your post, your hubby has had zero improvement.

I've mentioned this before, but I'll say it again... I'm currently out of work due to my CD, so I spend way too much time researching it. From what I've read, people that don't respond to steroids *usually* don't respond *as well* to the upper tier treatments. I'm only mentioning this because I don't want you to be disappointed if the upper tier stuff (6-mp, humira, remicade, methotrexate, etc.) don't help as much as you have heard they would. Many of them are billed as treatments for people that don't respond well to, or cannot tolerate, steroids. Unfortunately, what they are not so quick to tell you, is that people who's Crohn's did not respond well to steroids usually won't have as great of a benefit from the upper tier stuff. Emphasis on *usually*. That isn't to say that your hubby is doomed to a life of misery. Your GI may very well find a treatment program that greatly increases his quality of life, or possibly even puts him in remission.

I have mild CD, and even mild CD can destroy your quality of life. I just can't imagine what you and your hubby are going through.

I'm currently on week 4 of Humira. I have noticed alot of improvement in my arthritis, but only minimal improvement in CD symptoms. My doc also gave me a prescription of Imuran to go with the Humira, but I chickened out and didn't start it. I plan on starting it today, as well as getting the blood test done to make sure my liver can properly deal with it.

There is much debate in the GI world right now about how to treat CD. Many GI's are now recommending *at least* immediate steroid treatment, and others are saying it's best to start out right away with the big guns. I really wish I would have started with the big guns... maybe I'd be back to work by now.

Many people will argue this, but my opinion is go aggressive to start: Imuran and Humira.

Posted 2/21/2008 9:48 PM (GMT 0)
I would do both. All 4 GIs that I have been cared for under recommend taking them together. It helps prevent antibodies from building against the Remicade and helps enhance the Remicade.

I can't use Remicade any longer but it was a miracle drug for me for 2.5 years. Within a week after my intial dose, I had my life back. There are side effects to everything but I had to live for NOW and Remicade did that for me.

I'm now on Humira, and not Imuran anymore. Steroids only worked for me when in the hospital on IV - 50mg Prednisone did nothing for my latest flare. We were consulting with a surgeon about just cutting the sucker out when my ins company approved Humira (it was before it was approved by the FDA for Crohns). Wtihin a week of those loading doses, I was eating some solid foods. A month later, I was back to normal. An iron infusion later, I was feeling great.

Again, potential risks were there but my life needed to be lived now. Having my colon cut out and being out of work for 8 weeks wasn't my first choice in how to live. It may come to that one day but it was worth the risk to avoid it for now.

Good luck in your decisions - I'm sorry that he is so bad. I've been there and it drains the life out of everyone. I hope he responds quickly to whatever you decide.

(my GIs went with the 'big guns' theory as well)
Posted 2/21/2008 9:58 PM (GMT 0)
Hi newcrohnswife-

I'm on both also. I would check with your Dr. to see if this is a possibility. If the Remicade works for your husband, you will be so thankful. He will start to feel better so fast. And it's not too scary. Reactions happen, but there are sometimes ways to help with that. I take extra premeds. So, good luck. Hopefully you can pair the two up.

Cheers
Posted 2/21/2008 10:08 PM (GMT 0)
It is no longer recommeneded that you be on both imuran and remicade. I was on both up until last fall.
Posted 2/22/2008 2:21 AM (GMT 0)
What?!? chroniemomx2, more info please! how come?
Posted 2/22/2008 2:39 AM (GMT 0)
looks like i am going to be the only one chiming in on starting with the smaller stuff first then working your way up to the big guns. I personally was in a similar choice dilemma and i choice to try the Imuran method first. I would like to start off by saying A) It doesnt take 6 months, its dependant on the person, for me, i started Imuran in Sept 2006 and was feeling almost perfect by early Novemeber 2006, less then 2 months. It kept me in remission from then till November 2008 when i experienced a flare which i am pretty sure was due to the extreme stresss i was under for exams. I am now back under control and tapering off Prednisone. Anyways, i am still on 250mg/day of Imuran and only have to go for quick blood tests every 6 weeks, and of course Imuran is a LOT cheaper then Remicade, so i am glad i took this option first as it has saved me a lot of money and time and is very little work on my behalf.

Just weigh your options and go with what works best

Posted 2/22/2008 3:41 PM (GMT 0)
Like Darryl, I would not go to Remicade without trying Imuran first (or 6-MP or methotrexate). Even for people who do respond to Remicade, it is typical to ultimately lose response to it after using it for a while. That being the case, I think there is good reason to save it as a last resort, and give the less powerful drugs a chance to work first.

Posted 2/22/2008 3:47 PM (GMT 0)

I forgot to make a comment regarding the debate over whether people using Remicade should also taken another immunomodulating drug at the same time (azathioprine [Imuran], 6-MP, or methotrexate). It is often done to reduce the possibility of developing antibodies to Remicade. However, in postmarketing studies of Remicade, there were six cases (five fatal) of hepatosplenic T-cell lymphoma, a rare and aggressive cancer, in children and young adults taking Remicade together with azathioprine [Imuran] or 6-MP. That is why some doctors prefer not to have their patients on an immunosuppressive along with Remicade. Some are switching to the combination of methotrexate and Remicade, but there is no guarantee that this particular type of cancer will not occur on the methotrexate/Remicade combination as well.

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