Relative merits of Xeljanz vs. Imuran?

Hi,
Imuran would have been a good one to try while on budesonide (or prednisone which was my case), so as you were coming off it, the Imuran could take effect, which is typically 2-3 months.

I have been on Xeljanx for a little over a month and it is working great for me.
There are some days when I have no BMs and most days its in the 1-3 Bms per day.
I was on Entyvio before that and this one performs far superior to that.
Before I started on this med i had to have the Shingrix shot as Xeljanz can cause an outbreak of shingles.
I also get bloodwork done every couple of months to check on my cholesterol levels

https://medlineplus.gov/druginfo/meds/a682167.html

"Some teenage and young adult males who took azathioprine alone or with another medication called a tumor necrosis factor (TNF) blocker to treat Crohn's disease (a condition in which the body attacks the lining of the digestive tract causing pain, diarrhea, weight loss, and fever) or ulcerative colitis (a condition which causes swelling and sores in the lining of the colon [large intestine] and rectum) developed hepatosplenic T-cell lymphoma (HSTCL). HSTCL is a very serious type of cancer that often causes death within a short period of time. Azathioprine has not been approved by the Food and Drug Administration (FDA) for the treatment of Crohn's disease or ulcerative colitis, but doctors may sometimes prescribe azathioprine to treat these conditions"

Thanks, everyone. I'll let you know what my GI and I come up with.

I've not totally cooled down. Still minor urgency, 4 to 6 movements a day, about half of which are loose, and mild tenesmus. I'm much better than a month ago. I guess I still require some treatment besides Rowasa to achieve remission. Maybe a short course of Xeljanz is reasonable.

...and so it goes.

My appointment was just rescheduled to next Friday the 10th.

Yup, multiple meds seem to be the only way. I going to continue Rowasa enemas, Budesonide 9mg every other day, and probiotics morning and evening. Maybe tapering to Budesonide 6mg would work.

I've written my GI doc, but a timely answer is problematic. Compared to what many here are living with, I can't complain. Thanks, everyone.

Can you take lialda or one of the other oral mesalamine medications in addition to your rowasa enemas and budesonide? If I were you I would start that now.

Imuran is a good option but it does take a long time to work and you probably want to get off budesonide sooner than later, because of that, I'd likely be more apt to try xeljanz.

When was your last scope? Often options are based on where inflammation is active. If it's in your rectum, you might benefit from a steroid enema.

It sounds like there are a few things you can add to your current regimen before moving up the med ladder, but I would get the ducks in a row for the xeljanz (or imuran if you want to continue the budesonide for a while until imuran is in your system), while you try those things.

Traditionally, 1st class of UC meds was mesalamines (like lialda/rowasa), 2nd class was thiopurines (azathioprine/umran or 6MP), and then 3rd class was biologics (remicade/humira/entyvio and for the sake of simplicity xeljanz). Many docs are skipping thiopurines as they take 3-months to work and require ongoing blood monitoring (every 3 months while you are on this med). Thiopurines are simple, generic pills you swallow each day and pretty inexpensive. Whereas Biologics are expensive brandname meds.

The one caveat about thiopurines is they are known to reactivate latent cancers. Often they talk about prior melanomas (that is skin cancer) as being a reason not to take these meds. I know you've had prior prostate cancer and I am not sure whether that would be affected by thiopurines, but would be a good question for your doctors.

But is far as what thiopurines do: Thiopurines work by intentionally lowering the White Blood Cell count in your body. When we flare, our WBC count goes through the roof, and WBCs are the immune system's attack-dog, directly causing inflammation which causes the awful UC symptoms we know and loathe. The less WBC we have, the less inflammation can be caused, and the better we feel. However, we still need a safe amount of WBCs to counter common infections, cuts, etc so the blood monitoring is essential (as our WBCs can suddenly drop at any time for unknown reasons while on this med).

But I would at least have the conversation: what about thiopurines (and know I had a prior cancer)? Good to discuss all possible options and weight the pros and cons of various treatment routes, as part of the process of deciding what's the best path forward or you.

poopydoop said...
Checklist for xeljanz:
-Is this going to be a long term therapy (i.e. take it until it stops working, potentially forever) or a short course to induce remission?
-shingles vaccine (shingrix, not zostavax)
- pneumonia vaccine
- any other vaccines that are out of date nb you can't have live vaccines after you start immunotherapy

Good luck!

Yup, things like poopy mentions. Not sure if you need a TB test, or if you need evidence of trying other meds before insurance will approve xeljanz, but that's something your GI's office will likely handle. Have you tried steroid enemas or foam? One of those might be worth a try. It sounds like you've had a lot of positive progress and that's great!

Well I am still totally happy with Xeljanz for me. I don't miss having to rush off to the bathroom and can certainly go out with confidence and I no longer plan where bathrooms are so that I don't get caught out.

The next big test for me will come at the end of this month when my GI plans on reducing my dosage down to see if I can still stay being controlled on the lower dosage.
If not I will go back to the 10 mg twice a day.
One last point that someone else mentioned I also had the Pneumonia vaccine before I started with Xeljanz

Post Edited (limey) : 5/13/2019 7:34:43 AM (GMT-6)

I did mention in an earlier post that I had to have the shingles vaccine before they would let me start on Xeljanz.
I have had shingles twice in my life with many years between them.

From what I understand at the moment their intention is to take me straight down to 5mg twice a day.
I also asked about a combination of 1 x5 and 1 x 10 mg per day but I don't think they have considered that.
However they are going to send me a bottle of 5 mg plus a bottle of 10 mg so an easy switch if things don't work out.
Keep me posted on how the switch works for you.
Thanks

poopydoop said...
Hi limey (sorry to hijack this thread) how is your doctor planning to reduce the dose? Will you go directly to 2x5 mg or will there be a window with 1x10mg + 1x5mg? I am supposed to decrease my dose as of today but I am freaking out.

I was a slow responder to xeljanz (it took 5 weeks before i thought it *might* be working), i am told this is very unusual, but after 16 weeks i am in clinical, endoscopic and calprotectin remission.