Imuran effect after starting?

I am going to do combination therapy for CD ileitis, improperly diagnosed as UC for ~11 years. I'll try to bullet-point my questions and if anyone has experience or knowledge, I'd greatly appreciate it:

- I've discontinued asacol HD which I'd been taking for ~7 years. Should I notice a change?

- I am not scheduled for my first infusion for 9 days, so I am continuing my mesalamine rowasa enemas nightly in addition to the imuran...i understand this is ok, yes?

- I am taking 150mg of imuran, on day 3. So far I've noticed looser BMs but not greater frequency. Is this a common side effect? Will the side effects pass as my body adapts to the new medication?

- what should I expect when I start infusions of remicade and discontinue my rowasa enemas? I am most nervous about this, as it has helped my symptoms more than any other treatment I'd ever had and still is effective at minimizing urgency and frequency...

Overall I don't feel well, which is why I'm going full bore with combo therapy. That said, I am better symptomatically than I've been during other flares. Should I expect a step back before the combo therapy moves me two steps forward (ideally)? Is there a rule of thumb on how this all should feel?

I posted this in the CD forum but figured I'd try here as well. Since we take the same meds and most of my activity is in my colon. Once again all feedback/suggestions/answers are appreciated

iPoop said...
First, do not stop the asacol hd or rowasa now. Imuran is going to take 3 months to have an affect. Remicade can take 6 weeks or less to have an affect. I'd recommend you stay on everything until you've reached a sustained remission and then and only then remove the mesalamines.

The way it was put to me (by 3 GI doctors and 2 IBD specialists) was that the Asacol HD is not doing anything for me, as I don't have UC.

I'm a little torn about this. I used Asacol for over 10 years to treat misdiagnosed UC, which turns out was actually CD in my colon. I've been told that Mesalamine doesn't work for CD, so there's no need to keep using the Asacol or Rowasa. I'm definitely not stopping the latter until my first infusion.

In my GI doctor's words: "Mesalamine shouldn’t be necessary and I would like to see effect of Remicade with Imuran. You'll already be taking a lot of medication, so let’s see what we can achieve with those two agents. The incremental benefit of mesalamine enemas is very limited. I’ll continue to prescribe if you insist."

I am really kind of at a loss here. I felt like the Asacol was doing something, and the Rowasa was a relative game changer for years. If Imuran + Remicade don't start working right away, why would he suggest I stop what is? Do the two classes of drugs interact or offset each other in some ways?

There's no interaction, as you can see I'm currently on all of those (6MP instead of imuran but they're sister meds).

Mesalamine hasn't been proven to be effective with Crohn's disease as it has with ulcerative colitis. CD goes much, much deeper into the colon tissue and mesalamine has a topical effect.

I think it just comes down to mesalamine not being proven to work with Crohn's, and yes i do have ulcerative colitis. There's no reason other than that i can think of, as imuran/azathioprine is fine with mesalamines. We do have others here on aza and mesalamine simultaneously.

Just guessing here because I'm fairly new to IBD so don't have that much experience... but sounds like your doc wants to be able to see if the new drugs work, without guessing if it's them or the mesalamines? Or maybe he truly believes the mesalamines don't have any effect on your disease. But your experience is what's important, no? And you get to decide if you want to gamble on having a flare while you wait for the remicade to kick in. Personally, I'd keep up with the enemas and possibly cut back on the oral and quit it completely if cutting back make no difference in symptoms.