Almost six months on Imuran

So I started taking Imuran at May 17th in addition to oral Mesalamines(Salofalk). After around a month I upped the dose to 150 mg from 100. I barely missed a dose ever since and it doesn't seem enough. I'm still steroid dependent though I seem to need smaller doses of pred to maintain my daily routine. Does this mean I failed Aza? Can it take longer to take full effect? I had really high hopes for it.

Hi...I was on 200mg of Azathioprine and my symptoms kept going up and down. My GI determined (after 1 year) that I wasn't hitting the therapeutic range so he put me on 100mg of Allopurinal and reduced my Azathioprine to 25mg. That helped for a while and I did finally reach the therapeutic range, but it still wasn't enough to put me in remission.

You do need to get off of Pred first before really knowing for sure.

It sounds like Imuran is helping some but isn't helping enough. I'd look into a biologic medication like remicade/infliximab or humira as it's likely necessary for you. You've been on Imuran since May, so it is already at its full affect for you. No sense in waiting any longer.

A thioprine metabolites test will help see if you're within therapeutic range for Imuran, if you can get one. However, that test is generally confirming what's already known from your routine Complete BloodCell Count (CBC), Hepatic Function Panel (LFT) blood monitoring, and current uc symptoms. And usually your blood test results are the limiting factor as your wbc, must remain within a safe range with Imuran. If you're experiencing hypertoxicity within your liver then Allopurinal can avoid it, but only in that specific instance.

For some immunomodulators are their solution, for others it's just not enough on it's own. We only know if we try.

I added 6MP in January 2012 and begrugenly accepted Remicade in September of that same year. I stepped up 6MP, failed several pref tapers and was essentially prednisone-dependent at 20 mgs and a scope showing severe inflammation finally got me to accept my need for biologics. Remicade worked fast, I was off of pred within 3 month's time (by the start of 2013). I achieved remission thanks to Remicade for 2.5 years. I got rid of everything but Remicade and flared mildly as a consequence, now adding immunomodulators back and tapering off of pred. It's always a mystery on what we need to achieve remission, and then to sustain remission. Best we can do is try our best guesses...