Imuran or Biologic

Hummmm not sure on that one, as my doc now has me on both..days they've work really well together

Traditionally, one first got anti-inflammatory mesalamine, second immunomodulators (imuran/azathioprine or 6mp), and third biologics (remicade/humira) in that order. Some gasteroenterologists are now skipping immunomodulators for severe cases due to the 2-3 months it takes for those medications to work. Some gasteroenterologists are big proponents of a top-down approach of using the strongest medications first, especially in pancolitis cases and pediatric cases (hit UC hard and early to provide the best quality of life before UC has a chance to spread or increase in severity). Different schools of though, all equally valid, and it all depends on one's own philosophy.

The safety profile and side effects are very, very similar between biologics and immunomodulators. The recommendation is to be on immunomodulators and biologics simultaneously for best response and lowest odds of developing antibodies to your biologic.

Immunomodulators

Immunomodulators intentionally reduce our bodies white bloodcell count. WBC are our immune system's attack dog, directly causing inflammation in our large intestine which produces inflammation, bleeding, and urgency that we all know and hate. Immunomodulators reduce the amount of WBC we have and therefore improve our UC symptoms. They do require blood monitoring to make sure our WBC doesn't get too low.

Advantages: Immunomodulators are available in generic and a whole lot cheaper than biologics. Immunomodulators are a pill you take as you do now.

Disadvantages: Immunomodulators require routine blood monitoring, initially weekly, and reduced to biweekly, monthly, and finally trimonthly as long as you're on this medicine. As you get good bloodwork results back, the blood monitoring frequency is reduced. Immunomodulators take 2-3 months to work fully. So, you've got to be patient.

Biologics

Biologics interfere with our immune system's ability to signal or complete an attack. When we interrupt or mute the immune system's ability to attack and cause inflammation, our UC symptoms improve.

Advantages: Fast working, 6 weeks or less for a response. No blood monitoring required.

Disadvantages: Brandnamed-only in most countries (10-20% cheaper biosimilars have limited availablity in a few countries) a cost of $6,000 USD (or a whole lot more) a dose for those brandnamed biologics. Most of us on biologics use drug manufacturer patient assistance programs to help us afford them. Biologics are all intravenously given, either through an IV drip or an at home self injection. The IV must be done at a hospital or sometimes a gasteroenterologist office. So plan on driving to a hospital every 6-8 weeks with the IV biologics. Humira and simponi are self-injections you can do at home once a nurse shows you how.

My husband tried the immunomodulator first (6 MP). Supposedly it takes 2-3 months to kick in, but if you are not in agony, there may be no downside to giving it a try. The biologics are more work, and there is no guarantee. (Infusions / shots). You need to get liver function monitored while on Imuran or 6MP.

For us, it didn't work on its own, so then he went to biologics as a next step. He stayed on the 6 MP while on Remicade (which ultimately didn't work). The thought was that taking an immunosuppressant with a biologic might inhibit the development of antibodies. That wasn't the case for him.