Medication decision: 6 MP again, or biologics?

Given your past reaction to 6mp, I'd choose a biologic. I'd bet the same thing as last time would occur.

You can get the TPMT test before starting 6mp to see how well you will ultimately tolerate it:
www.ncbi.nlm.nih.gov/pubmed/15298741

Some can use 6mp at a much lower dose when combined with allopurinol, and achieve therapeutic range safely without a toxicity response (you had one before). www.ncbi.nlm.nih.gov/pmc/articles/PMC2659140/

Yeah NSSG was on the allopurinol + 6MP combo. She ended up getting sepsis while on it, but I don't think that's very common. I've heard the allopurinol requires biweekly blood monitoring the whole time you're on it. Whereas 6MP only, can be trimonthly the duration you're on it.

Biologics don't require bloodwork.

Hi Songlady,
Is Entyvio an option? I like that it is gut specific so I personally would look there if it is a possibility.
B

Thanks, everyone.
Remi or Humira? Or just see what my insurance and the various patient assistance programs do, financially, to help me make a decision?

I think remicade is the better choice BUT I did have a negative experience with humira so I know that has influenced my opinion. Humira was originally approved for crohn's then later UC. If you are not interested in getting an infusion and would prefer an injection, I would ask for simponi. Ultimately, your insurance may be the deciding factor. When I briefly used humira, I wanted simponi and my insurance required that I try and fail humira first. When I had side effects, my GI at the time didn't want me to try simponi so I went back on remicade. When making your decision, I would research it instead of gambling with insurance. A GI doc once told me that simponi is more equivalent to remicade and the reason I chose it was because it was designed for UC. If you have a relatively good quality of life with your UC, maybe try entyvio since it takes several months to see results and save remicade for later use. That is probably what I would do now if faced with the decision to go up the drug pyramid and not been on a biologic yet.

Hi...I cant give suggestions on meds, but what areas are increasing in inflammation? And by how much?

q

Thanks, nssg and Q! I appreciate your input and good questions.

I have not had a colonoscopy since early February, so.. I would want him to take a look before I started anything new. There was microscopic inflammation in the far side of the transverse at my last two scopings, last October (when the serrated polyp was reported by pathology) and February (which was to look at it further but it did not show up on pathology despite dye used in the scoping and many more biopsies. So Dr. thought maybe the reporting of the serrated polyp had been a mistake - ?)
Prior to that, my inflammation had tended to be about 14/16 inches up, below that being addressed by the enemas, we figured; and then a cecal patch.

Actually, I had slacked on the probiotics, and now I have started those up again in earnest; they have helped me in the past. And I am doing a stint of nightly steroid enemas (I believe I finally got those things into my signature!) The mesalamine enemas have never done anything for me, unfortunately.

Unless it is a fluke, the past few days I have had 2-3 BMs per day, beautifully formed (pieces of art indeed!) with no urgency. I had seen a little blood on the toilet paper after the first morning BM several weeks ago, which seemed to me was likely low inflammation since it was only in the first BM and not subsequent ones; and this despite nightly Canasa. Hence the enemas.
Given that late August/early Sept is my "flare time" this was not bad at all. I think the 6 MP was just beginning to kick in, gut-wise, and likely helped.

My GI really does encourage meds and going up the ladder, it seems to me. We need to have a little heart-to-heart.

These questions just seem to come up as the years pass, don't they, OH?

NSSG, I have tried diet mod, and I seem to do fine if I am moderate in all foods. Since my symptoms are not the issue, but rather microscopic inflammation, it's had to get a handle on it all!

I talked with my GI.
I reported that, doing steroid enemas every night and probiotics each day (VSL and also Ultimate Flora 30 Billion, different times of day) I feel great. 2-3 formed BMs each day.

We agreed I would continue the enemas nightly for a 4th week, then go to every other night for several weeks. We will talk again in about 4 weeks unless something comes up.

I expressed that I am open to biologics IF he takes a look and sees inflammation is still present; he thought that was reasonable, and suggested that even a flex sig might show enough. Or, he suggested that if I continue to feel good, we could just wait until February for my annual colonoscopy and make a decision at that point. If not "pristine" I would go for a biologic. I am too nervous about 6MP at this point. (As iPoop suggested, I think the "flu" I had 5-6 weeks into 6 MP was a reaction. I had right ribcage pain, even though it started out as a respiratory illness.)

As to which biologic, my insurance will likely have the decisive voice. (I also found out that he offers infusions in both his offices in two towns.)

To add to the thinking, I am going on a tour, US to France, for 10 days, two weeks from now. So I am committed to feeling good on that trip!

Thanks, John!
Yes, I have gotten my head around the biologics issue and am willing to go there. But I would like a look-see to show that this progression is actually warranted.
I feel good about all this. I mean, as good as one can with UC and all... just sayin'....

Right, DB. You had pointed that out before.

Right now I am going to hope for the best with my enemas and probiotics. Always the optimist, lol....!