Imuran or not?

Hi There,
I have U proctitis since 2001. I was in the remission since 2004 without any medication
using asacol time to time- just to be protective. Last year February after my regular colonoscopy -which was my colon perfect clear-, and after physical exam for prostate in March, I have noticed something different and I start asacol right away, and then July came, flare-up badly.
august -sept 10- 12 urgency in a day. October I start 4 week predizone, no help. hydrocortisone no help either. Last month my sigmaodoscopy show I have very severe colitis for first 35cm from rectum to up. I start using salofax anema right after sigmadoscopy and in two weeks my urgency, gas reduced 90% now I have 2-3 bowel movement in a day, and have blood very little- reduced substantially. I feel better I saw my specialist yesterday and He wants me to start Imuran right away, continuing with asacol and Salofax as well. I am reluctant to start Imuran since it has too much side effect as well as cancer risk. I did all my test, looks I am fine to take it. My doctor said salofax wont do it. It is just temporary. I trust him but I have concern about it.

I am torn apart, Please comment......

I am 50 years old now. If I use Imuran now, what will happen 10 years later....
10 years I was in the remission with no special diet.

How much Asacol are you taking? Personally, I would skip the Imuran and take 4.8 grams of Asacol per day and take enemas and suppositories once or twice a week. This is not something you do while flaring and then quit when in remission. You need to do these things all the time, forever, and then maybe you wouldn't have to take Imuran. I would at least give it a shot first. If it doesn't do the trick then you go on Imuran.

Hi Gary
9 tablet a day and salafox anema every night.
you may be right I should have taken forever but I managed it 10 years. My concern was if you take the medicine forever, eventually when you flare up, it does not work anymore, if it works nobody has flare up again. but I may be wrong in my theory.
Thanks for the reply.

Why not choose healing with more mesalamine plus a steroid or mesalamine enemas. Apriso is something I like.
You shouldn't come off anti-inflammatories like Asacol; it prevents you from getting inflammation you would likely not notice. If you notice a small amount of change you might add enema's.
Many take orals mesalamine daily and might weekly or every 3 days use enema's (or as necessary) but never leaving them for long. I'd discuss more with GI - search other posts in here and you'll see a lot on that topic alone "maintenance" meds.

If you need azathioprine though:
I do notice healing slower (I also take Remicade). Have to stay on any fungus or bacterial infections (prevention is best; if cut, clean and protect and avoid bare feet in gyms).

Increased risk of skin cancer; I get monthly blood work (CDC) to verify no marrow hypoplasia. Lymphoma risk discussed further in here (below).

Lol juststud, if I get said shirts printed then you'd be the very first to get one. I write documentation for a software company which is very repetitive by nature/necessity. It could also happen here, it could also happen here...

Clin Gastroenterol Hepatol. 2014 May 28. pii: S1542-3565(14)00767-8. doi: 10.1016/j.cgh.2014.05.015. [Epub ahead of print]
Risk of Lymphoma in Patients With Inflammatory Bowel Disease Treated With Azathioprine and 6-Mercaptopurine: A Meta-analysis.
Kotlyar DS1, Lewis JD2, Beaugerie L3, Tierney A4, Brensinger CM4, Gisbert JP5, Loftus EV Jr6, Peyrin-Biroulet L7, Blonski WC8, Van Domselaar M9, Chaparro M5, Sandilya S10, Bewtra M2, Beigel F11, Biancone L12, Lichtenstein GR13.
Author information
Abstract
BACKGROUND & AIMS:
Thiopurine therapy for inflammatory bowel disease (IBD) has been associated with increased risk for lymphoma. We estimated the relative risk of lymphoma in patients with IBD exposed to thiopurines and compared relative risk values derived from population-based studies with those from referral center-based studies. We investigated whether active use increased risk compared with past use, and whether sex, age, or duration of use affects risk of lymphoma.

METHODS:
We searched MEDLINE, EMBASE, and Cochrane databases, as well as conference abstracts and international publications, for the terms "6-MP and lymphoma," "6-mercaptopurine and lymphoma," "thiopurines and lymphoma," "azathioprine and cancer and IBD," "azathioprine and malignancy and IBD," "azathioprine and lymphoma," and "lymphoproliferative and thiopurines." Pooled standardized incidence ratios (SIRs) and 95% confidence intervals (CIs) were estimated. The deviance statistic from Poisson models was used to calculate heterogeneity.

RESULTS:
Eighteen studies (among 4383 citations) met our inclusion criteria. Overall, the SIR for lymphoma was 4.92 (95% CI, 3.10-7.78), ranging from 2.80 (95% CI, 1.82-4.32) in 8 population studies to 9.24 (95% CI, 4.69-18.2) in 10 referral studies. Population studies demonstrated an increased risk among current users (SIR = 5.71; 95% CI, 3.72-10.1) but not former users (SIR = 1.42; 95% CI, 0.86-2.34). Level of risk became significant after 1 year of exposure. Men have a greater risk than women (relative risk = 1.98; P < .05); both sexes were at increased risk for lymphoma (SIR for men = 4.50; 95% CI = 3.71-5.40 and SIR for women = 2.29; 95% CI = 1.69-3.05). Patients younger than 30 years had the highest relative risk (SIR = 6.99; 95% CI, 2.99-16.4); younger men had the highest risk. The absolute risk was highest in patients older than 50 years (1:354 cases per patient-year, with a relative risk of 4.78).

CONCLUSIONS:
Compared with studies from referral centers, population-based studies of IBD patients show a lower but significantly increased risk of lymphoma among patients taking thiopurines. The increased risk does not appear to persist after discontinuation of therapy. Patients over 50 have the highest absolute risk of lymphoma per year on thiopurines, while men under 35 may also be a high risk group. More study is needed to precisely understand groups highest at risk. The risks of lymphoma and potential benefits of therapy should be considered for all patients with IBD.

I would be careful since you are over 50, you have the highest absolute risk of lymphoma on Imuran at 1/354 or 0.28% increase PER YEAR on Imuran according to this study done in 2014

Post Edited (fightUC) : 3/4/2015 4:23:56 AM (GMT-7)

It's an interesting study but I thought where they got their data was odd? They just created criteria and did searches. Who is to say the studies were valid? That was my initial thought.

Soy stud hasnt posted here, i think u mean dreadsteel 😎😎😎😎