Simponi vs Azathioprine drugs

Hi there,

New to forum - so diagnosed with proctitis 2017- by sigmoidoscopy. Was in remission on mesalamine with a flare here and there that pred cleared it. Then has scope in October as stool sample showed high inflammation levels but abs no symptoms maybe 2 solid BM a day. Scope showed inflammation. I had baby last year and was perfect pregnancy.
Now they want me to go on Simponi and I have said no. So tired the pentesa (mesalamine) granualas but today entered a bad dose of a flare.

I am just researching and I don't know why they didn't offer me Azathioprine drug like Imuran ?

They said when I asked absolutely nothing else for me only Simponi which isn't go if you want another baby which I will do soon.

Has anyone been in similar situation ? I've been lucky I have been very lucky with symptoms have not been had since diagnosis but I guess can't have active inflammation so they want me on biologics but I am reluctant to go on as plan to try for another baby maybe next year sometime ?

Ugh - Azathioprine! It works well for some people but I have low TPMT levels so I had side effects with it, and was switched to 6MP (6-mercaptopurine). Neither worked, and both gave me side effects.

If you do decide you want to try Azathioprine or 6MP make sure you get your TPMT levels tested.

Post Edited (UCyousee) : 11/24/2021 4:08:54 AM (GMT-7)

Hi there,

Thanks for replies! My GI said it's not safe really. She just said we will cross that hurdle when we get there. Possibly can stay on it for up to 23 weeks. Is Imuran safe for pregnancy ?

I just thought giving Imuran a go before the biologics made sense but I don't know enough I guess.

Thanks both! How did you get on Biologics ?
Which ones were you guys on?

The crohns forum has had some ladies that had Remicade babies without any issues. Both mom & the babies were perfectly healthy. From what I have read about Imuran on several medical sites, it would not be my choice of a drug when entertaining the thoughts of getting pregnant.

Good luck with whatever you & the dr decide.

This is from the website of crohns and colitis uk. Simponi and remicade are both tnf-inhibitors. Golimumab = simponi

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Golimumab does not affect fertility. If you don’t want to get pregnant you should use contraception.

Talk to your IBD team if you're taking golimumab and planning a pregnancy or are already pregnant. If you decide to continue taking golimumab, it should not stop you from having a normal pregnancy and a healthy baby. Research shows that anti-TNF medicines, like golimumab, do not have affect your pregnancy, or harm your baby. Long-term health, infection rates and development do not appear to be affected in children of mothers taking anti-TNFs during pregnancy. This includes mothers who took anti-TNFs until birth).

Golimumab does not appear to affect foetuses, but there hasn’t been enough research to rule out the possibility completely. To be cautious, drug companies state that should only be used during pregnancy if needed to keep your condition under control. This is because the medicine could cross the placenta. They recommend using contraception to prevent pregnancy while taking golimumab and for at least six months after your last dose. However, as golimumab is generally considered safe. Your IBD team may advise the safest option is to keep taking it during pregnancy to keep your Colitis under control.

When deciding whether to continue taking golimumab, you should also consider the risks of having a flare-up while you’re pregnant. Having active Crohn’s or Colitis can lead to premature (early) birth, low birth weight and rates of miscarriage. It’s important to keep your condition under control in pregnancy. If your Colitis is not well controlled (in remission), then your IBD team may recommend you take golimumab for the first six months (first and second trimesters), but stop during the third trimester. This aims to reduce the exposure of your baby. If your condition is not well controlled, your IBD team may recommend you take golimumab throughout your entire pregnancy to keep you well.

Taking golimumab during pregnancy is likely to affect when your baby can have any live vaccines. This includes the BCG for tuberculosis and the rotavirus vaccine. It should not affect the rest of your baby’s vaccination schedule.

National guidance advises that if you take golimumab during your pregnancy your baby should not have live vaccines until they are at least six months old. However, golimumab drug companies advise that your baby should not have any live vaccines for six months after your last adalimumab dose during pregnancy.

You must tell your baby’s healthcare team you were taking golimumab while pregnant. Decisions on what vaccines your baby should have and when they should have them needs to be made on an individual basis. Your IBD team and midwife should be able to help you come to a decision.

Take extra care if your baby does have the rotavirus vaccine, as live virus can be shed in the baby’s poo for up to 14 days. Make sure you wash your hands and/or wear gloves when changing their nappy.

There is some evidence that your baby may be more prone to infections if you take azathioprine or mercaptopurine along with anti-TNFs, like golimumab, during pregnancy.

Discuss the risks and benefits of taking golimumab while pregnant with your doctor and IBD team. You can find out more in our information on pregnancy and reproductive health.

There is less research on men wanting to father a child while taking anti-TNF medicines. But, it’s generally considered safe for a man to conceive a child.

Hi there,


Thank you so so much for the response! I am in Ireland. They are pushing Simponi because there is some trial with it going on at the hospital I'm in. It was only today when I pushed back with questions did they say they might look at another one beginning with "A" I think I didn't quiet catch the name. They said they wouldn't allow me go on Imuran as a young women they said the risks and side effects are worse with this than biologics.

I am meeting my GP tomorrow to discuss and see should I get a second opinion from another GI locally.