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Ending Azathioprine

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Ulcerative Colitis
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Posted 7/23/2011 11:25 AM (GMT 0)
I've got UC and have been on Azathioprine for the last 5 years.

I have a blood test every 3 months and they have come back OK every time.

My doc has stated that I should now consider stopping the medication to prevent any toxicity problems.

But I'm not sure how. All he says is "It's a gamble. If you stay on the medication, it could become toxic and give you a cancer in the lymphatic cells of the immune system. If you stop the medication, you could have a relapse of your UC."

When I ask "should I taper the drug off, or stop it completely?" I get little support.

Anyone else had this issue?
Posted 7/23/2011 12:42 PM (GMT 0)
Back in the 90s when I was on the sister-drug, 6MP, my GI also indicated 5 years only for that drug. I quit cold turkey, there were no side effects and 6MP did not need to be tapered.

Sue
Posted 7/23/2011 1:18 PM (GMT 0)
You can stop azathioprine without a taper. Because of the nature of the drug it takes a few weeks to get out of your system, so it sort of does its own taper.
Posted 7/23/2011 2:30 PM (GMT 0)
You don't have to taper. My doc wants me to taper to prevent a flare, which I'd rather do instead of stopping cold turkey.
Posted 7/23/2011 7:58 PM (GMT 0)
Ok, so I guess the next question would have to be: What happens once the Azathioprine is out of my system? I've not had a single episode of UC whilst taking it, so I'm a bit concerned that stopping it alltogether will cause a relapse like what I had before the Az, with frequent dosages of Prednisolone in an attempt to get it under control, but of course I can't stay on it due to the toxicity effect.
Posted 7/23/2011 9:40 PM (GMT 0)
I have not heard that you can't stay on Aza long-term. I am on 6mp and I have been for between 1 and 2 years and my doctor hasn't mentioned that I would have to stop it at some point. I do think if you stop, there is a good chance your remisson will come to an end at some point. It may be in a month or it may be in a few years... 6mp/Imuran stay in your system for quite a while after stopping them so you may not notice a difference in symptoms right away but the real test will be whether you notice symptoms 3 or 4 months down the line. I have temporarily stopped 6mp without having a relapse in my condition but I have never stopped for more than a month or two. I stopped because my blood counts dropped too low.

Did Azathioprine work for you right away?
Are you taking anything else?
Posted 7/23/2011 10:29 PM (GMT 0)
The Azathioprine took about 4 - 6 weeks to begin working, but once it started I've not had any problems in the last 5 years. The problem is that everyone says you shouldn't use it for longer than 5 years.

My only other medication is 1600mg of Asacol (mesalamine) per day. Maybe the GI will suggest increasing this?
Posted 7/24/2011 12:27 AM (GMT 0)
I've been thinking about taking azathioprine again and have been reading up on the subject.  There's a 2004 study by Marla Dubinsky that discusses discontinuation of the drug.

In a nutshell, studies have found that there may not be much benefit of taking azathioprine after 4-5 years and that relapse isn't a sure thing after discontinuation.  This study doesn't find any problems with "indefinite use."

This study is quite clear, though, that azathioprine shouldn't be mixed with mesalamines.  If you haven't had any bad reactions over the years, and your bloodwork has been fine, no harm, no foul in your case.  Perhaps your GI is worried about the continued combination.

Overall, I'd guess your GI is expecting the Asacol to continue the remission.  And, though I haven't looked at them in awhile, there are studies that show even mesalamines can be discontinued after a long period of remission and mucosal healing. 

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