Which mesalamine while pregnant ???

Hello in 30 weeks pregnant. Started having symptoms first time ever at 17 weeks was diagnosed w flex sig and labs at 19 weeks. Started asacol HD + uceris but switched to delzicol over Christmas bc I read about DBP in the asacol HD. Since then went backwards and had to d/c uceris for prednisone. Tapered to 20 and am now having full fledged symptoms w bloody stools. Nervous bc of baby. Stick w delzicol or switch back to asacol HD despite the DBP ?? Called my GI and she said its my call In meantime upping the prednisone to 30.

I am not sure - I have only done Remicade while pregnant. In fact, I am currently 31 weeks pregnant. But ask your GI about doing budesonide instead of prednisone. It isn't as systemic as prednisone and is less like to affect your baby.

beave said...
GMSAF, do you have UC or Crohn's? If it's Crohn's, why are you bothering with UC meds (asacol, delzicol, etc)? They have been shown to be ineffective for Crohn's.

Can't answer the OP's question I'm afraid, but I can answer this.

The memo that mesalazines don't work for Crohn's hasn't reached GIs yet. They still prescribe mesalazines for Crohn's, almost without exception as far as I can tell. I consider my GI to be a decent doctor and yet all he wanted to prescribe for my 'mild' Crohn's of the rectum and neo terminal ileum was mesalazine enemas. Insisted that was the best thing for it.

GMSAF said...
I think we are assuming my disease is mainly in my colon, I had an mr enterography without evidence of disease anywhere else

I think what beave says is true for Crohn's colitis as well though. If the reason that mesalazine doesn't work very well (or not at all) for Crohn's is because the inflammation goes through all layers of the bowel - unlike UC, where the inflammation affects the inner lining only - then that would apply to Crohn's colitis as well as small bowel Crohn's.

I'm feeling way, way, way too lazy to dig out studies on Crohn's and mesalazine and try to isolate the Crohn's colitis patients, but one of these days I might do it. Might.

Edit: Forgot to add that mesalazine is a topical med which doesn't penetrate any further than the surface mucosa of the bowel. For UC, that's fair enough, but for Crohn's... not so much so.

Post Edited (NiceCupOfTea) : 2/9/2016 9:28:35 AM (GMT-7)

lol, good point @beave, I totally missed that. :)

I wonder if they hesitate on starting Remi or another biologic while pregnant? I know they are pretty safe for pregnancy, but that's after you've been on them and have established you won't have a poor first reaction to them. It might make sense to try some lower-level meds first?

Exactly the reason they're sticking w sulfasalazine/mesalazine levels are because I was not on any established Med before pregnancy and they wanna start those after if things don't go away. Also re my crohns colitis , I was awake for the procedure and I do agree that things looked patchy instead of continuous which would go e crohns but my Prometheus genetic tests were more in line with UC. But I mean crohns is patchy and this was patchy. I will consider remicade/Humera soon because this many weeks of prednisone (at 25-30 for 5 weeks now) can't be good for the baby either.

Thank you very much for all your input I appreciate it a lot.

The biopsies showed moderate colitis and proctitis. And yes you're right they're holding off for the full scope until after the birth!