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Azathioprine and mesalazine have't worked. Starting regular infliximab. question????

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Ulcerative Colitis
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Posted 4/6/2013 11:24 AM (GMT 0)
Back in September 2012, last year, I began a very severe flare which I was firstly given prednisolone 40g, mesalazine 4.8g and Pentasa enemas which I took at these doses for 2 months with no success. In November Azathioprine 125g was added however 2 weeks after this and continued deterioration my consultant got me admitted to hospital for nearly 3 weeks. In hospital I was on 100ml of IV steroids, along with 4.8g mesalazine and 125g Azathioprine. This time the IV steroids did NOTHING and after 2.5 weeks on them was given the Infliximab infusion. I quickly reached remission after first infusion however I received another 2 infusions anyway, the last being at the beginning of January 2013 this year.

I have taken the azathioprine 125mg ever since the beginning of Novemeber, the infliximab was supposed to fill the GAP where azathioprine takes 12 weeks to begin working. I have remained symptom free since my first infliximab infusion in November and believed the Azathioprine would have kicked in and kept me in remission since my last infliximab infusion in January.

However I have noticed the last week I am getting flare symptoms. I have a feeling of urgency, a lot of blood in loose stools, mucus. Doctor has decided that azathioprine clearly hasn't worked for me and will start me on regular infliximab infusions.

Was wondering, if i am on regular infliximab will i be able to stop taking the azathioprine and mesalazine now??
Posted 4/6/2013 11:41 AM (GMT 0)
Maybe. I am taking Imuran and going back onto Remicade. Have you had blood tests to check if your azathioprine is working? If it is, you may be on both. If it is not, you may 'bridge' on it until your Remicade levels are up.
Posted 4/6/2013 11:48 AM (GMT 0)
I see! thanks for the reply. I had a blood test a while ago to check my azathioprine levels. Dr said that would take 4 weeks to come back, i'm sure the results are probably back by now but i never chased up the results. I will definitely do this on monday though once my dr is back from the weekend. Don't want to take azathioprine anymore if it's doing nothing for me, but then don't want to stop if its doing something.
Posted 4/6/2013 12:04 PM (GMT 0)
My doctor took me off azathioprine when I was in remission from the infliximab. At the time there were a couple of studies showing that the combination of those two drugs led to a minutely increased incidence of lymphoma, and the aza hadn't really worked for me anyway.

I continue to take a 5-ASA because it was able to control the inflammation in much of my colon (all but the left side) and because it has been shown to have some preventive value for colon cancer.

My guess is that your symptom relief would be from the infliximab, and the aza was probably not doing much. See what the results of your test tell you.
Posted 4/6/2013 2:23 PM (GMT 0)
I don't see the point in taking azathioprine if it's not working.
Posted 4/6/2013 10:00 PM (GMT 0)
Thanks for replies, yeah hopefully i'll get off the azathioprine soon as it hasn't helped. feeling pretty crappy now. symptoms of this most recent flare only started a week ago and that was literally a bit of mucus, and now theres already lots of blood and pain that i'm needing constant analgesics (buscopan and co-codamol). I hope the infliximab infusion is started soon as this deterioration is quick!

I never really saw the big deal with this disease and I assumed that if you took medicine you'd always be well. However now I'm learning quickly this isn't the case for all and the disease is scaring me and I worry about what might happen in the future if the infliximab stops working like every other medicine has failed for me so far. Sort of feel like I'm delaying the inevitable. My uncle had ulcerative colitis and had his entire bowel removed maybe 15-20 years ago and now lives with a colostomy bag. Wondering if I have a genetic predisposition that medicine doesn't work for our type of UC and surgery is my likely future also. Scares the crap out of me.
Posted 4/6/2013 11:14 PM (GMT 0)
You're so young, I bet you'll live to see a dramatic treatment or even a cure! So many of these auto-immune disorders are related, and there is so much research.

I'm thinking all of the baby boomers getting arthritis will benefit us ;)

I've had 'oh crap this is a REAL disease' UC since I first got it two years ago. I failed medicines before I even knew what they were. My GI wants me to see a surgeon in June if my tissue isn't healing by then. I'm just not quite ready to 'give up' on my colon.
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