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Moderate Crohns & Drug Choices (6MP vs Humira)

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Crohn's Disease
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Posted 5/29/2013 8:09 PM (GMT 0)
Hi Everyone,

I know a lot of people on the forums are having a lot of issues with their disease, but I thought it might be good to pose a question to the group of Moderate Crohns sufferers. I deal with Crohns and have good and bad days based on diet/time of the month mainly. Especially bad days if I eat the wrong thing or experiment with something I haven't tried in a while. BTW I have two known strictures.

I had a small bowel follow through earlier this year and a scan of my guts and it's confirmed I have two strictures and a lot of inflammation, to the point the radiologist said are you in a lot of pain? and I said no? well sometimes but not all the time and not at that moment. confused

My Dr stopped Entocort, because he felt it wasn't helping and said to try 6MP or a biologic such as Remicade or Humira. He thinks the biologic would work the best. I have been on 6MP in the past but chickened out because of the risk of cancer, although low. I was thinking about Humira, imagining eating things again that I just can't eat right now, but in the midst of research came across possible, rare, side effects of MS something my grandmother had and not exactly reversible once you stop the drug. Oh yeah and cancer, of course.

Now I am not so sure what to do. If my quality of life is not greatly suffering is Humira too far a step for me? I know a lot of people turn to it because they have 0 quality of life but right now, I go out, I do things and I deal with my bad days but mainly keep on going.

Just an inner struggle, I think I want to exhaust 6 MP before attempting a biologic, but thought it might be a good thread to start, when faced with more extreme (side effect wise) drug choices and moderate disease, what's the right decision?

Thanks,
Randi
Posted 5/29/2013 8:26 PM (GMT 0)
Another question I'd ask the DR is about the possibility that a biologic might make the strictures worse. It seems that some people here have had the experience that the biologic meds induce healing in a way that causes more stricturing, at least in the short term. For those with already restricted passages that can create obstructions.

https://www.healingwell.com/community/default.aspx?f=17&m=1408237 and others here, you should search healingwell.

http://www.crohns-sanity.org/forum/index.php?topic=7733.0
Posted 5/29/2013 8:57 PM (GMT 0)
Kazbern, thanks for reminding me of that I definately saw comments around that issue which has made me more hesitant. Honestly the more I hear I think trying 6MP first may be the better decision.

I was actually worried that I wouldn't be able to swallow the 6MP pill since I had an issue, although a long time ago, with a normal tylenol getting stuck and causing me a lot of pain.

I only take rapid release now which works much better.
Posted 5/29/2013 10:40 PM (GMT 0)
I think I would try 6MP before a biologic, too. I did ask my GI about Remicade making strictures worse and he reckoned it wouldn't happen. It was a while ago, so I don't remember exact words but he said if they were caused by inflammation, the Remicade would make them go away. That said, kazbern is right: there is a still unresolved controversy about whether Remicade can worsen strictures through rapid mucosal healing. The only thing that is agreed upon is that Remicade is useless for strictures created by scar tissue. So before going on a biologic, do try to find out if your strictures are caused primarily by inflammation: an MRI scan can help determine this.

All the Crohn's drugs, even the 5-ASAs, come with rare but serious complications. However, they pale in significance to letting Crohn's inflammation fester away. I don't mean to scare you but if you ignore it, things will just get worse. Your strictures will get narrower, creating obstructions, and you'll almost certainly end up having to have surgery - possibly emergency surgery.

6MP comes in very small tablets so they're easy to swallow - don't worry about that. Heck of a lot easier than having Remicade infusions. If you do decide to go on 6MP, my suggestion is to start on a low dose and work your way up as tolerated, as it can make you feel nauseous in the beginning. However, it does wear off. Also, regular blood checks to keep an eye on your blood cell count for the first 3 months are mandatory. A small minority of people cannot tolerate 6MP (or its sister med, azathioprine), and blood tests are a way of monitoring this.

Good luck!
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