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6mp + Remicade. Opinions?

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Ulcerative Colitis
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Posted 6/3/2010 12:26 AM (GMT 0)
Just saw the GI today. He is pleased with my progress, but wants to add 6mp to the mix.

Let me back track and update on my current status. I am going about 2-3 times/day, fully formed, no visible blood, no issues with urgency. I will have my 4th Remicade infusion tomorrow, and I am currently down to 7.5mg on the pred taper. I have not had any issues with the taper thus far, and I don't anticipate having any. (not that it isn't possible, but I really don't expect any issues) So I am doing well. I am still anemic, but not losing blood, so it is just a matter of continuing to build back up on that front. I would consider myself to be more or less in remission-at least darn close to it.

So I am really unsure about adding 6mp right now. I am not against it entirely, but am not sure it is the right time to do it. Things are going well, though I know that given how I failed on Humira, it is likely the same will eventually happen with Remicade-and I think he feels like getting me on 6mp as well will help my chances of staying in a long term remission. He said the research shows that the combo works better, and when I asked him about increased cancer risk, he said he does not find that to be true-though how he can be sure of this, i don't know. I also asked him about the use of 6mp during pregnancy, since we are discussing trying for a 3rd, possibly this fall. He said that in his 30 years as a GI, he has not seen any of his patients who have been on 6mp during pregnancy have any problems or defects or anything. But it is rated as a category D, so my thought is that if I don't need it right now, maybe it would be better to hold off until after a pregnancy? I don't know-but I feel like being on the Remicade is enough of a worry during pregnancy without adding in another toxic drug.

I am just really on the fence about this. I am going to do some research, but also wanted to hear everyone's thoughts here. Opinions???

Thank you all!!
Posted 6/3/2010 2:02 AM (GMT 0)
I was started on 6MP after my second infusion...I just had my 3rd about 2 weeks ago. I was also told that they also work well together. I believe it can also help to keep your body from developing anti bodies to the Remicade but not positive...I thought I read that somewhere. You will definitely be very immuno-compromised on both. I'm down to 2.5mg of prednisione at the moment and hope to be off it within the week. What mg did he want you to start and what dosage of remicade are you on?
Posted 6/3/2010 2:28 AM (GMT 0)
     All I can tell you is what my GI told me.  He took me off the 6MP two weeks prior to starting Remicade because he knew of a few cases (on young men though) where they had fatalities....I don't want to alarm you, but only stating what I was told.   My GI was always super, super cautious with my meds.  He didn't want me on the 6MP along with Remicade because of the cancer risk.  This may be due to my age also.  I am a LOT older than most of you in here and the older you get, the greater the cancer risk.
Posted 6/3/2010 2:51 AM (GMT 0)
Thank you Gordon and Christine for your input!

Gordon-I should know my Remi dosage, but I don't. I have only had the loading doses so far-tomorrow will be the last loading dose. That is very interesting about the antibodies-I will have to ask him about that as well. As far as the 6mp dose, he wrote the script for 50mg pills, two daily, but told me to start off with one a day.

Christine-that is definitely something to think about, and I would prefer my GI be a bit more cautious with meds. One of my biggest concerns right now is the potential for a pregnancy. While I realize that people have been on 6mp during pregnancy without issue, I feel like if I can do without it during pregnancy, that would be preferred. I just don't see taking additional risks if they are not necessary.

I think I need to talk more with him about this. I think I will also consult with my OB/GYN and my Integrative MD as well, just to get a few more opinions. I am sure it will annoy my GI, but I don't want to rush into taking another drug.

Sometimes I think I should just scrap all of these drugs and go for surgery-but then being able to be in remission lures me in (like the remicade has), and I think maybe the meds aren't so bad!
Posted 6/3/2010 4:24 AM (GMT 0)
My doctor told me he wants to keep me on Imuran if I end up needing to start Remicade but he said we would lower the dose to 100mg or maybe even 50mg depending on how I do. The reason I mention that is I think 6mp is stronger so, maybe ask your doctor if you really need 100mg. Maybe 50 would be enough?
Posted 6/3/2010 11:23 AM (GMT 0)
I was on 100mg prior to my hospital stay and once on Remicade he felt 50mg is enough and he said no longer than 6 months. If you haven't already, you can read about the cancer risks here:

http://www.ccfa.org/about/news/cancerrisksexplained
Posted 6/3/2010 1:00 PM (GMT 0)
Supa,
I'm in a pretty similar situation. I started Remicade but had a possible allergic reaction so took some time between the first and second infusion (the second one is set for tomorrow). In the meantime, my doc put me on 6MP. I am also close to remission (I don't know if it is the prednisone or the 6MP or what), and I am hesitant to go through with the Remicade treatment. However, my doc, like yours, thinks I will have better long term success on Remicade if I take the 6MP in conjunction w/ the Remicade. He told me the latest studies indicate that 6MP increases and prolongs the efficacy of Remicade.

He did acknowledge that the cancer risk may be slightly higher with the combo but that it is still a rather remote possibility. He also said that my chance of getting colon cancer is probably a more pressing concern if I don't get my U.C. under control (I had never thought about it that way before).

I know it is a hard decision. Maybe you could ask your doctor if you hold off on the 6MP and if the Remicade doesn't seem to be working so well in the future then start the 6MP, or if it would be too late to start it that point.
Bridget
Posted 6/3/2010 1:14 PM (GMT 0)
We were told that the policy at the Hospital for Sick Kids in Toronto is that they will not give the two drugs at the same time. I may not have the numbers exactly right but I think we were told there had been 19 cases of lymphoma in kids in the states that had been taking both drugs. I do not know what that percentage would be but obviously very small. They did say that they felt they were being over cautious but there was enough concern to warrant the decision. I know a lot of doctors sit on the fence about this and when weighing all the options sometimes feel it is okay....it is a tough decision
Posted 6/3/2010 1:29 PM (GMT 0)
Collicat,
I think I read in several places that many (if not most) of the cases of cancer being attributed to the combo were young adolescent boys, so it makes sense that a children's hospital would be reluctant to prescribe the combo. I've never seen an explanation for why young men seem to be more susceptible to this.
Bridget
Posted 6/3/2010 3:36 PM (GMT 0)
I completely agree with your take on this. I also agree that the worry of colon cancer from the years of inflammation is greater than than the remi/6mp combo.

It is all a concern and up to your docs and yourself to determine the best course of action...there are no easy answers.
Posted 6/3/2010 6:16 PM (GMT 0)
I'm on Azathioprine aswell as Remicade and they're not thinking of taking me off the Aza just yet. I hate having to take both because I don't think it is necessarily a great combination, as others on here have said. But I'm hoping to come off the Aza soon as the Remicade seems to be doing the trick.
Posted 6/3/2010 9:03 PM (GMT 0)
Thanks all. My doc said the same about the colon cancer risk being much higher with an inflamed colon versus the additional risk of doing the combo of meds.

Bridget-I do think one of his goals is to get me on the 6mp (and Jennifer, he said 50mg/day might be enough and that I might be able to stay on a lower dose) because my flares seem to come on very fast and go from reasonable to severe in a matter of days. He had wanted to go the immunosuppresant route before I was hospitalized this last time, but I just didn't have time to wait months for them to kick in, which is why I started on the Remicade instead. So I think his thought is that if I am on both, I could stay in remission longer, and then if things do start going south, we could increase the 6mp dose right away.

Not a bad idea, and I am not completely against it-I just feel like I need some other opinions about it, particularly in terms of pregnancy since that is on our minds at the moment.

Thanks again-I really appreciate the input!!
Posted 10/11/2013 3:39 AM (GMT 0)
I see this thread was started a while ago...I have a question.
So, while I was at the hospital, my GI said he wanted to start 6mp, but said that due to the drug taking effect only 3 weeks after starting, he couldn't bc i had to have Remi as an emergency, so, now that I am out of danger and it has been a week since Remi, instead of Remi, could I start 6mp instead?
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