Experiences of Azathioprine (Imuran)

Hello Everyone,

I was diagnosed with Crohn's disease in January 2017 after suffering a bad flare. So far I have been extremely lucky, I was able to get the disease under control with steroids, and have been in complete symptomatic remission ever since (taking Pentasa twice daily to avoid another flare).

From the moment I got my diagnosis my consultant has been very keen to put me on Azathioprine (Imuran), he believes that I can achieve complete histological remission if I take it for a year or two. I understand what he is saying, but the medication i'm currently on is obviously doing the job so I'm reluctant to go on immunosuppressants unless its necessary (I haven't had another colonoscopy/fecal calcaprotein test since my diagnosis so I have no idea whether there is still active disease present in my colon).

I have a good understanding of the medication and its side effects (luckily I work in a laboratory that preforms therapeutic drug monitoring for Thiopurine treatments). However, I'm worried that it will be a big commitment (regular blood tests) and that I'll experience (perhaps debilitating) side effects.

To gain a better insight I would love to hear your experiences of azathioprine. Was it effective? Did you experience any side effects? Was it difficult fitting regular blood tests into your everyday lives?

Thank you in advance!

If you've acheived remission after one bout of Prednisone a year ago, then you've done extremely well. I would contend that the Pentasa isn't doing a thing to maintain your remission though. Pentasa has been deemed an antiquated therapy by most GI's now. Your remission may simply be your body and the way it behaves. I would keep a very close eye out for symptoms. You should have regular diagnostics done to keep up with any and all disease activity.

Crohn's can be active even at microscopic levels, so you really want to keep it under control. As far as Imuran, it can be very effective for some, and not sufficient for others. As a previous poster mentioned, the medication response is a very individual thing. As for the drug itself, it's been around for a very long time now, and for the most part is very well tolerated.

Well i dont like the thought of taking those medications either an my doctor hasnt said i need to take any since my surgery , but if your doctor says you should maybe you should, if it gives you bad side effects you can come off it so maybe you should try an see how you go with it

1.) "Did you experience any side effects?"

I've been on 6MP, which is a sister medication of Imuran, since 2012 and I have not experienced any side effects from it. Imuran/Azathioprine is metabolized into 6MP within the body, so I save a step. I was a little nervous when starting this as a new class of medications as well. What helped me was looking at the actual risks versus benefits and the Crohn's and Colitis Foundation of America has some great info on it:
Webcast: programs.rmei.com/CCFA139VL/presentation/player.html
Transcript: http://www.ccfa.org/assets/pdfs/risk-and-benefits-transcript.pdf

When initially starting Imuran, about 20% of patients experience nausea that usually goes away in less than a month's time. To reduce the odds of experiencing nausea, take your Imuran just before bedtime with a snack.

2.) "Was it difficult fitting regular blood tests into your everyday lives? "

Regarding the blood testing, it starts frequently, and then is reduced as you get back good blood test results. I started at weekly blood testing, it was reduced to every-other-week tests, to monthly tests, then every-other-month tests, and finally to tri-monthly. Right now I get a blood test every three months, which isn't that bad or that much of an inconvenience.

3.) "Was it effective?"

I ended up needing Remicade in addition, as 6MP wasn't enough on its own for my IBD severity.