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5-ASA Drugs confusion

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Crohn's Disease
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Posted 1/7/2011 4:32 PM (GMT 0)
OK, I'm really trying to get a handle on drug options.  I hear a lot of y'all talk about different 5-ASA medications that seem to help, yet my son's doctor has said that since his inflamation is in his small intestine, those type of drugs are not beneficial.  She said they only work on the large intestine.  Am I missing something there?  We are still trying to find an alternative to Remicade and the more I hear from people the more I realize we need to get him on some drug therapy. 

Also, is it possible to go on 6-MP's without doing steroids at all?  And is that any safer than Remicade?

Thanks for your help


Julie

Posted 1/7/2011 4:46 PM (GMT 0)
Hi Julie, which part of his small bowl is effected?
My inflammation was in the TI and first part of ascending colon and my GI prescribed Pentasa, which is mesalamine like the other 5-ASA drugs, but is targeted to that area.
Posted 1/7/2011 4:50 PM (GMT 0)
The inflamation is in his Ileum.
Posted 1/7/2011 4:53 PM (GMT 0)
What she says is mostly true. Most of the 5-ASAs are designed to release in the colon, such as Lialda. However the capsules Pentasa and Apriso are designed to release at the end of the small intestine, treat that, and work their way through the colon. That's how my dr's explained it anyways.

I don't really know about the 6mp, I was on the sister drug Imuran, but it suppressed my immune system too much and caused too many side effects that I didn't realize was caused by it till after I was off. I didn't have to take steroids all the time with it. Others could answer better me.
Posted 1/7/2011 5:00 PM (GMT 0)
Yes you can start a med like 6mp without having to be on the steroids. But...most docs when you are flaring will put you on Prednisone first to help quiet the inflammation and also because 6mp can take 3-4 months to reach full efficacy, so the steroids help to calm things down till the 6mp kicks in.

Before I had my resections whenever I flared my docs always put me on Pred and Pentasa to control the flares. My CD is in the Terminal Ileum/Cecum area. After my resections I successfully use Asacol, and my Crohns has not moved, just the areas where CD developed are removed and reconnected. I like Asacol so much better than Pentasa personally. I had alot of minor side effects with Pentasa that I don't with Asacol. By others have ALOT of sucess with Pentasa, and others don't. Good luck!
Posted 1/7/2011 6:28 PM (GMT 0)
I had the opposite results from Nanners. I started on Asacol (when my GI knew I had inflammation in the rectum and cecum) and that got rid of the blood, but not the diarrhea. After a lot of complaining I switched to Pentasa and it was like the difference between night and day.

I have gastritis and esophagitis and "treat" that by taking a ppi. I have never had imaging done in my small bowel, but I assume that I have some inflammation there because I am not symptom free, even though during my last scope (2 years ago) the GI only saw inflammation at the rectum (cecum and TI were clear).

I think Pentasa or Apriso are worth a shot.
Posted 1/7/2011 10:38 PM (GMT 0)
Pentasa releases through the ENTIRE small intestine (including the duodenum/jejunum) and ends in the ileum and part of the colon. Asacol releases mainly in the terminal ileum (the far end of the ileum) and colon.

So for the ileum, either Pentasa or Asacol could work. If one doesn't do the job, you could try the other. Also, their release mechanisms are different. Asacol is sensitive to PH - when it reaches the ileum and a PH of 7, it starts releasing (working). Pentasa, on the other hand, releases gradually throughout the small intestine and part of the colon.  

Lialda is another option, but I'm not as well informed about that med. Check out the following link from Johns Hopkins hospital for more info: 

http://www.hopkins-gi.org/GDL_Disease.aspx?CurrentUDV=31&GDL_Cat_id=AF793A59-B736-42CB-9E1F-E79D2B9FC358&GDL_Disease_id=291F2209-F8A9-4011-8094-11EC9BF3100E

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