Side Effects in Biologics versus Imuran??

Hi everyone.. I'm a fairly new diagnosis to Crohns but have been suffering for about 20 years. My GI dr. thinks Imuran would be a good first step. He said if I don't do well with it we can look in to Humira. After reading up about it and scanning the net for personal experiences, it seems that the side effects and risks of Imuran are a lot higher than biologic meds like Humira. Can anyone shed some light on this? The idea of pancreatitis probably scares me the most followed by the increased skin cancer risk with Imuran. It also seems like more people have nausea with Imuran than with Humira. I know Humira is considered a higher step drug than Imuran but my dr. made it sound like I could choose to start with a biologic if I wanted. He said at this time my Crohn's is clinically mild but that he recommends we treat it now based on my symptoms of waking up at night and not being able to eat any fruits or veggies.. even when well cooked my diet is really limited from anything that's not white bread or processed. Any feedback on the side effects of Imuran versus Humira would be great.. thank you so much!

Hi Sweetpizza and welcome, fellow newbie here!

I don’t have any comparison of the two but I can fully relate to your worries. Long story short, I now had to start Imuran (week three) and so far so good. It takes 3-6 months to work though, something to bear in mind. I was also started on Remicade.

Not sure if you’re in the UK but if you are, beware of the NHS and their budget approach. They like to start you on the cheapest drug (immunosurpressant if steroids unsuitable). Well actually, they’re not offering Azathioprine but the branded version so you’re probably not in the UK. :lol

Where is your disease located in your gastrointestinal tract? How mild/severe is it? Have you had colonoscopies and small bowel MRIs or just colonoscopies?

Do you think you've had Crohn's for 20 years but just recently got the diagnosis?

Do you have any other medical conditions or Rx medications you take?

There are similarities - and differences - in the risks of side effects of imuran and biologics. As discussed, imuran has the risk of pancreatitis or liver damage - but frequent blood work when you start it usually keeps you on top of any such issues. If you start having problems, you stop it and the problems usually go away quickly. And there's the increased risk of infections, as well as non-melanoma skin cancer and lymphoma (a small risk). Also the med can take several weeks, even a few months, to work.

Humira is generally more effective. But it costs way more. And it too has increased risks of infection, non melanoma skin cancers, lymphoma, and other issues. But of course most people don't get those things.

It's not at all uncommon to be on BOTH imuran and a biologic. Studies show they work together in combination, and the imuran helps prevent you from developing antibodies to the biologic, so you can stay on it longer on average.

So which to start first? If you're doing fairly well and your disease isn't out of control, you could start with imuran and see how you do. If, after a few months you're no better, or perhaps worse, then you know you'll need to try biologics. If you can't tolerate it for some reason, you'll know that as well.

If, on the other hand, your disease is pretty significant, you might want to start a biologic sooner rather than later. Biologics tend to work quicker and better. And if you wait too long while the disease is doing damage to your colon and/or small bowel, some of that damage can become irreversible, in which case there's only so much the biologic can do. So it's often good to get one one before that happens. If you're higher risk for aggressive disease, it's better to get on biologics sooner.

In any case, it's now recommended that people on either imuran or a biologic like humira or remicade get routine skin checks with a dermatologist.