forming questions for GI appointment...Imuran vs Biologics?

I've always considered biologics the bigger guns that Imuran. Not sure if that's justified or not, however. I think they both carry an incremental, but small in relative terms, increased risk of lymphoma and an increased risk of certain skin cancers (some reports say melanoma, others just say basal cell carcinoma--my info might be out of date).

The additional issue that has me more wary of biologics than Imuran is that biologics come with an increased risk of serious opportunistic infection according to my rheumatologist--he said 5% of people on them get challenging infections and he considers them something to be used when a person's quality of life demands it, but not before. That is, of course, just his view point. I've been on Imuran for years and have had no issues with it to date, including no increased number of colds, etc--if you don't tolerate it well, there's careful monitoring while you're on it to pick that up hopefully quickly.

I would ask your GI which he recommends. Why he recommends one or the other. What his patients' experience has been with side effects (serious and minor). If he recommends one biologic over another, why does he recommend that one.

I've been on both immunomodulators and biologics and haven't experienced any side effects from them. They do happen but are rare. What these medications can do is reduce your inflammation levels which lowers your colorectal cancer odds and improves your quality of life. Simmering inflammation isn't good over the long term, can spread and trigger a flare much sooner than if you're in remission.

I don't think your current symptoms warrant biologics, its to soon for them. A low dose immunomodulator might knock out your symptoms.

Generally, I'd always try immunomodulators before biologics. Immunomodulators are step 2 after mesalamines in most gastroenterologist practices and literature. Immunomodulators are much more affordable since they are available in generic form as 6mp or azathioprine (a few hundred dollars for a 30 day supply). Biologics are many thousands of dollars each dose. It's also much more convenient to pop a pill with immunomodulators than with biologics that necessitate you self-injecting humira or have a nurse set an IV for remicade. Often you need immunomodulators to get the best results from biologics anyways, so starting with immunomodulators makes a whole lot of sense.

Actually, Immunomodulators and biologics both have very similar side effects and safety profiles. They're both drugs that slightly lower your immune system's capabilities and that ends up giving very similar low risk side effects. You have a slight elevation in risk for colds and flus (an extra cold a year). The elevated risk of infections (uti, bronchitis, sinus, etc.) applies to both immunomodulators and biologics.

Actually the mesalamine you take now already has rare risk of serious side effects (inflammation of liver, kidneys, heart, and blood abnormalities). There's risk in many things we do but as long as that risk is low we don't often think about it. Other things have risk that we don't often consider like death in a car crash is 1 in 133 odds, risk of death due to heart troubles is 1 in 5. Risk versus benefit is always an important consideration.

Uncontrolled uc inflammation is far more dangerous than the side effects of immunomodulators or biologics. It's mostly about risks versus benefits. Immunomodulators have 70 percent odds of improving your uc symptoms and the risk of serious side effects are less than 1 percent.The Crohn's and Colitis Foundation of America has great information on this that I found helpful
programs.rmei.com/CCFA139VL/presentation/player.html
Transcript: www.ccfa.org/assets/pdfs/risk-and-benefits-transcript.pdf

We all have risk tolerances and there's times when you legitimately need to take a risk. With chronic illness, quality of life is the biggest goal. Uc can get worse over time, and it's necessary to update your treatment plan accordingly. Simmering inflammation isn't a good thing as it increases our risk of uc spreading in extent and severity, and increases the risk of flares and colorectal cancer. While being in a deep remission has been shown to provide the longest periods without uc symptoms, less frequent flares, less severe flares, and the best quality of life. So, I wouldn't be afraid of the next step in uc treatment whether that's immunomodulators, biologics, or even surgery. Uc needs to be controlled and managed. And I sincerely believe that our own hesitation to take that next step, only prolongs our suffering from our horrible uc symptoms. Yeah you might not be doing badly, but how much better would it be to forget about uc due to a solid remission?

I chose 6mp over biologics simply because I didn't want to spend all day at the infusion center each month or two. It just seemed easier to me. It also worked well for me compared to biologics. It's a personal decision. I guess you have to weigh the options and figure out what is best for you. Some of the biologics, like simponi are administered at home, and that's pretty easy, probably easier than 1 pill a day. Unfortunately it didn't do anything for my condition.