HealingWell
Search Close Search
☰

Clean colonscopy-dr wants to decrease Imuran

Support Forums
>
Ulcerative Colitis
✚ New Topic ✚ Reply
❬ ❬ Previous Thread |Next Thread ❭ ❭
Posted 10/4/2018 1:35 PM (GMT 0)
Hi all!
Like many out there in remission I haven’t posted in a while. First, the good news...I just had my 3rd clean colonscopy and still in remission counting on almost 3 years. Given this, and assuming my biopsies show no inflammation my dr wants to check my remicade levels and if they are high, he wants to decrease dosage of imuran.

Has anyone decreased imuran with remicade? I don’t want to rock the boat especially if I keep all things the same I’ve been given the 5 year pass on my next scope. He thinks we can decrease imuran and check remicade levels regularly but would need scopes every year still. I’m just looking to weigh the choices. Any input would be appreciated!!!
Posted 10/4/2018 1:52 PM (GMT 0)
Welcome back and congrats on the clean scopes!

Of course reducing any medication dosing has the chance of returning you to a flare. However, as you've been stable withing a remission it is plausible that you no longer need such a high dosage of imuran. A dosage reduction would take a minimum of 6-weeks to have an affect on you although it might take much longer to truly know you are safe. I did flare mildly after stopping 6mp, it happened 6-months later (about average for discontinuing them) but my GI said I was the exception rather than the normal outcome of that.
Posted 10/4/2018 2:20 PM (GMT 0)
It may be relevant to consider that Imuran is serving two roles. 1) it has a direct effect in producing remission. 2) by preventing Remicade antibodies, it has an indirect role by preserving the effectiveness of Remicade.

Typically a lower dose is used for antibody control. Tapering Imuran down from 150 to a lower dose typical of what is needed for antibody control may be reasonable given growing concern about multi-year use of thiopurines.
Posted 10/4/2018 2:22 PM (GMT 0)
Thanks John...good info. Let’s see what my biopsies look like and I’ll decide from there.
Posted 10/4/2018 2:25 PM (GMT 0)
Thanks DB, that actually makes sense. So since I hit remission now imuran s only role is to keep me from building up antibodies and to do this it doesn’t require a high dosage?
Posted 10/4/2018 2:28 PM (GMT 0)
Regarding preventing antibodies, the majority of information I've read over the years says the highest risk of antibodies is:
1.) When initially starting a biologic. To our bodies, biologics are tiny, foreign proteins much like viruses are. Our body's immune system is therefore tuned to attack such invaders upon first exposure. When we've been on a biologic for 6-months or more, the odds of forming antibodies is greatly reduced (our immune system tried, couldn't figure it out, and gave up). Often they'll say start thiopurines with a biologic and then discontinue thioprines after 6-months time.
2.) Discontinuing a biologic is a common time to develop antibodies. When we defeat a virus and it's numbers are rapidly falling, our immune system starts looking at the pieces of those viruses that are still floating around within our circulatory system and trying once again to beat that virus, just in case we are exposed again or to something similar. Beating a virus doesn't mean we found antibodies to it (it could've been a weak virus killed by raising body temperature, WBCs, and other non-antibody means), but it's easier to make antibodies when the virus is defenseless, broken, and readily available in the bloodstream.
Posted 10/4/2018 6:59 PM (GMT 0)

Kulinarykidz said...
Thanks DB, that actually makes sense. So since I hit remission now imuran s only role is to keep me from building up antibodies and to do this it doesn’t require a high dosage?

Yes sorta.

See ipoop's comment about periods of greatest antibody risk. But, some people did develop antibodies after years.

I say sorta because we can't know how much you need Imuran to keep inflammation at bay. But on the theory it is not needed for maintenance, then what I said. IF you taper Imuran and flare, then we get a clearer picture.
Posted 10/4/2018 8:34 PM (GMT 0)
Great info. I’ll keep you posted on my progress and decision. I’m tempted to stay on just to get a 4 year break from colonscopies!
✚ New Topic ✚ Reply