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Imuran vs prednisone

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Ulcerative Colitis
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Posted 1/5/2011 1:17 AM (GMT 0)
Was at the GI today and he is recommending Imuran. When I've been researching this tonight it seems that this is normally a go to drug if prednisone isn't working. I was on pred for a very short time during a hospital stay and shortly after before getting a GI but was not on it again.
In your opinion are people generally on pred before Imuran? I've never been in remission but am not having severe symptoms anymore. We just can't seem to get on top of it. I have asked to have a colonoscopy just to make sure the whole colon is still involved or if maybe enemas might work.
I know it's pretty bad when I'm requesting scopes!! LOL!
Posted 1/5/2011 1:30 AM (GMT 0)
I would only use pred for a major flare. It can't be used as a maintenance medication, so IMHO Imuran is probably a better option for you if your flare is mild and not being controlled by mesalamine. It's a good idea to try the rectal meds before moving on to heavier drugs if you aren't on any though! :o)
Posted 1/5/2011 2:05 AM (GMT 0)
Sobroken, I can't really speak to the Imuran question -- I came in the thread to see if anyone had answers :-) -- but I wanted to just note that I told my GI a few months ago that I had a sense that enemas might be a good idea, and he had no problem prescribing them for me. I haven't quite hit remission, either, but the steroid enemas really make an enormous difference. I don't think you need to go through another colonoscopy before trying the enemas.
Posted 1/5/2011 2:16 AM (GMT 0)
@ ugh - that makes sense. I never think of these questions when I'm sitting in the office:)

@ janey - Because I have pancolitis this was never really on the table. The reason I'm having the scope is a cross your fingers
kinda thing. He's pretty sure it's still far up and I'm crossing my fingers that it's not!!
Posted 1/5/2011 2:30 AM (GMT 0)
I think it's a good idea to give the enemas a try but if they don't work, you may opt to try soething like imuran to keep your immune system in check. You probably wouldn't want to go on pred if your symptoms are mild, it's really an awful drug and it sounds like even after your stay in the hospital where you were on steriods, you've still been experiencing symptoms. The thing about imuran is that it can take up to 3 months to rreach the right level in your system. If you're having problems, I can understand your GI wanting to get you on it now, before you end up on prednisone. i wish I had started 6mp sooner, I waited, kept trying different 5ASA medications and none of them were helping, I ended up on prednisone and unable to taper off because the flare kept coming back. Now, months later, I am finally seeing my levels in the right place and my condition seems to be more stable. I can't say I have any regrets because I did what I thought was best at the time, I thought maybe colazal or Lialda would help and I wanted to try these options before resorting to 6mp but now that I am taking 6mp, it hasn't been too much trouble. You do need freqent bloodwork, especially in the beginning but it's just one or two pills a day.
Posted 1/5/2011 3:08 AM (GMT 0)
Your original question was do people typically use prednisone before using Imuran.  The answer is clearly yes.  Imuran is considered a steroid sparing medication.  As we all know one cannot take prednisone indefinitely.  It has horrible side effect and is infact quite dangeroius to take long term.  It's so dangerous that GI docs will recommend Imuran instead. 

The 5 ASA meds weren't working for me and hene the Imuran.  It has worked very well for me and it has put me into a solid remission.  My most recent scope was just 2 months ago and the GI doc was very pleased to see a 95% healed colon.  No side effects for me, just feeling better about my colitis in general.

I would definitely consider using it.

MyUC

Posted 1/5/2011 3:36 AM (GMT 0)
I personally think your GI is incorrect in thinking that because you have pancolitis, you do not need enemas. I was also diagnosed with pancolits, and my GI first started me on Asacol alone, to see how I'd do and because he didn't think I could hold the enemas long enough to do any good. After 1 week, I noticed a VERY slight improvement, and he prescribed the enemas. They immediately made a big difference. The enemas do an amazing job (MUCH better than oral meds) at treating the end of the colon.

I kind of wonder if it's hard to get a pancolitis flare under control w/o enemas. Here's what I'm thinking: since the oral meds don't do a very good job at all at treating the end of the colon, and it's therefore still very inflammed, maybe the inflammation in that part of the colon "encourages" (I can't really think of a word to use there) inflammation in the higher portions of the colon. I don't know if that makes any sense.....

If I were you, I would NOT, under any circumstances, go on Imuran before trying the mesalamine enemas in addition to oral mesalamine.
Posted 1/5/2011 5:50 AM (GMT 0)
Hi! I just wanted to say that as a 20 year old female who was diagnosed with pancolitis at 13 (following and followed by hospitalizations of 3-4 days each), I would definitely say go for the Imuran, certainly after or instead of Prednisone.

I had the misfortune of being left on Prednisone for almost a year after my initial flair, which did help to moderate the symptoms, but certainly didn't do away with them entirely. I got a second opinion from another doctor, who was horrified with what the side effects of the steroid had done(bloating, continual discomfort, constant sweating, really unfortunate stretch marks for a freshman, reddened skin, and general grossness) , and immediately switched me to Imuran, which I've been on (in varying dosages) ever since.

That switch put the colitis into remission, which has been disturbed only a handful of times, and never for more than half a month, in the 6 or so years since. As far as I can tell, I have suffered no noticeable side effects, aside from a few more colds than I used to get.

What's more, I just had a colonoscopy this morning, and everything checked out as fine!
Posted 1/5/2011 12:39 PM (GMT 0)
I, too wanted to weigh in on the enema thing. I've had pancolitis since 1991, but I've addressed all my flares through enemas, either Rowasa or steroid - or both (one in morning, one in evening.) Twice my inflammation has clearly been in the transverse and my doc had wanted me to do "a short course of pred" but because I'd had such a lengthy and bad experience with it when first dxed, I bargained with him - "Please let me try 3 weeks of enemas first and if that doesn't work, we'll do the pred...." and each time the enemas worked.

In any case, the enemas, by calming the bottom of the system, have brought me comfort and have lessened the more bothersome symptoms quickly.
Keep us posted on what you do!
Posted 1/5/2011 2:10 PM (GMT 0)
I agree try the enemas before trying the Imuran. There's a process you have to go through to start Imuran which is a lot of blood work. Then once you are on the Imuran you have more blood work so that the doctors can monitor your kidney function. Imuran should be second option if the enemas don't work.
Posted 1/5/2011 2:39 PM (GMT 0)
Thanks for all your quick replies. I find it strange that enemas aren't automatically prescribed since people feel so strongly about them.
I think I've decided to have the scope because I'd really like to know how things are looking, and then discuss trying enemas.
I'd rather not have any stronger drugs if at all possible.
I'm going away for a couple of weeks in February and have my scope scheduled when I get back. I'll post what happens!
Posted 1/5/2011 4:12 PM (GMT 0)
Why not try convincing your doc to go ahead and prescribe the enemas? That way, if you get better, you won't even have to mess with the scope!
Posted 1/5/2011 8:00 PM (GMT 0)
Sobroken, I completely support you in doing what's right for you, and in addition, I'd like to just add my own perspective. I know that I'm inclined to be a little controlling and I try to manage stuff that isn't always manageable, and one of my tendencies is to try to gather all the "facts" around situations that may or may not rely on those facts. I've only had one colonoscopy, and I've had to fight the urge to ask my GI for another, but what I keep telling myself is that the real issue for me isn't what the invasive procedure tells me, it's what my body tells me.

I don't have pancolitis, but when I first mentioned enemas to my doctor, he said, more or less, well, why not give it a try. He thought the enema wouldn't reach far enough to make that big a difference, but honestly, I saw an immediate and very marked improvement. Again, not to try to convince you to change your mind, but only to share my experience, I would WAY rather go through the minimal effort of trying the enemas to see whether they work as opposed to the prep for and hassle of the colonoscopy. For me, it involved taking 1 1/2 days off of work (1/2 day for the prep, 1 day for the procedure), and I really hate to do that if I can avoid it.
Posted 1/5/2011 8:30 PM (GMT 0)

I just want to clarify my position a little clearer.  I am a big fan of the rectal meds, wheter it's enemas or suppositories depending on high or low the inflammation is.  I too had pancolitis and the ASA meds weren't doing anything for me.  The imuran healed my colon well and I am trying to wean myself off the Imuran and get on rectal meds only.  It's very important what is being said.  The rectum is where uc starts and where it ends.  The thinking is that if one can control this area then one can keep a good grip on their colitis.  I initially started on 200 mg of Imuran and then lowered it to 150 mg with no noticeable effects.  I have since added Canasa since there is only a small patch of inflammation in my rectum.  My GI doc and I made a deal.  I will stay on the Canasa for the next six months and do a flex scope in late spring.  If that area has healed then I am to lower my Imuran dosage to 100 mg. 

The point I am trying to make is that I don't like being on Imuran.  But I don't like having UC either.  If I have to live with this uc thing then I will Imuran as necessary but ideally I would like to be just on rectal meds.  Imuran as a drug has worked very well for me thus far and it has it's place but rectal meds are good too.

MyUC

Posted 1/6/2011 3:39 AM (GMT 0)
I'm assuming at this point that my GI knows more about UC then I do. I didn't feel comfortable with starting the Imuran without being fully aware of what's going on, hence the scope. I will definitely ask about doing the enemas no matter what just on the overwhelming response but if he feels that the Imuran is the way to go then I'm going to follow his advice. I agree with MyUC that I will do what needs to be done to get in remission including rectal meds:)
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