immunomodulators and TNF blockers . . . which is more severe?

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medieval_peasant
Regular Member


Date Joined Mar 2009
Total Posts : 52
   Posted 3/10/2009 7:11 PM (GMT -7)   
I am trying to figure out why immunomodulators are considered as a step below TNF blockers in the treatment of Crohn's disease.  If TNF blockers are supposed to target a specific antibody and therefore reduce overall immune system suppression, then is it not a safer and more effective treatment than say 6mp?  Steroids also reduce the immune system as a whole, why then do they not stand above TNF therapy?  If anyone can answer my questions or point me to a medical journal article that explains this, please let me know.  Thanks.

Rider Fan
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Date Joined May 2008
Total Posts : 1445
   Posted 3/10/2009 7:26 PM (GMT -7)   
Great question. I think the reason is that the TNF's are newer, so they don't know as much about the long term effects.

6MP is a heavy duty drug for sure, but we also take lower dosages. 6MP has some cancer risk concern, as do TNF's.

Every treatment has it's possible drawbacks. Some doctors now are starting to use TNF's right off the bat rather than use Asacol then 6MP then TNF's...
32 y/o male. Dx'ed in 1999. No surgeries.

Current meds: Humira. 22.5mg prednisone. Udo's Choice Probiotics (30 billion).

Tried SCD, didn't work, now avoiding gluten and dairy.


sjkly
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Date Joined Dec 2007
Total Posts : 2113
   Posted 3/10/2009 7:29 PM (GMT -7)   
Mtx and Plaquenil and other DMARDS are a step less extreem in their immune suppression.
Prednisone actually suppresses the immune system more then the DMARDS.

Although the TNFs target a specific part of the immune system rather then the whole immune system they are much more powerful and leave you much more prone to infection.

medieval_peasant
Regular Member


Date Joined Mar 2009
Total Posts : 52
   Posted 3/10/2009 7:29 PM (GMT -7)   
My doctor is one of the doctor's doing this.  He taking from Penasa straight to TNF blockers.  Thanks for your reply.

Rider Fan
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Date Joined May 2008
Total Posts : 1445
   Posted 3/10/2009 7:32 PM (GMT -7)   
Good luck! Which one?
32 y/o male. Dx'ed in 1999. No surgeries.

Current meds: Humira. 22.5mg prednisone. Udo's Choice Probiotics (30 billion).

Tried SCD, didn't work, now avoiding gluten and dairy.


medieval_peasant
Regular Member


Date Joined Mar 2009
Total Posts : 52
   Posted 3/10/2009 7:36 PM (GMT -7)   
Humira since it is less likely to be rejected by my system.  (Remicade is part mouse)

Rider Fan
Veteran Member


Date Joined May 2008
Total Posts : 1445
   Posted 3/10/2009 7:40 PM (GMT -7)   
I just started Humira, good luck to both of us.
32 y/o male. Dx'ed in 1999. No surgeries.

Current meds: Humira. 22.5mg prednisone. Udo's Choice Probiotics (30 billion).

Tried SCD, didn't work, now avoiding gluten and dairy.


medieval_peasant
Regular Member


Date Joined Mar 2009
Total Posts : 52
   Posted 3/10/2009 7:49 PM (GMT -7)   
Any adverse reactions yet?

Rider Fan
Veteran Member


Date Joined May 2008
Total Posts : 1445
   Posted 3/11/2009 7:56 AM (GMT -7)   
Nope!
32 y/o male. Dx'ed in 1999. No surgeries.

Current meds: Humira. 22.5mg prednisone. Udo's Choice Probiotics (30 billion).

Tried SCD, didn't work, now avoiding gluten and dairy.


LookingForHope
New Member


Date Joined Mar 2009
Total Posts : 3
   Posted 3/11/2009 8:06 AM (GMT -7)   
Did your doctor ever want you to do Imuran before Humira?

My doc just said he wanted me to go on Imuran... but has mentioned Humira before so I am trying to figure out if going on Imuran first is what I am supposed to do.

Illini
Regular Member


Date Joined Dec 2007
Total Posts : 298
   Posted 3/11/2009 11:56 AM (GMT -7)   
Like it was said before, steroids and 6mp, imuran, etc. are considered "more safe" because they have a longer history of clinical use and the side-effects or poor outcomes are well established. TNF blockers are new, less understood, and we have no idea what the long-term effects will be. When you decide what medication to take, there is a cost-benefit analysis. With the TNF blockers you can't really make an informed decision because part of the "cost" equation is still missing.

TNF blockers could also be considered more severe because (1) they require infusion or injection, versus oral (2) you can develop serum sickness, infusion reaction, lups-like symptoms or full-blown lupus, a fatal infection, cancer, and so on, and (3) cost is MUCH higher.

Some doctors are now advocating a "top-down" approach where they start newer Crohn's patients on a TNF-blocker (and possibly immunosuppressants as well) to establish a more lasting remission, skipping over the 5-ASA's or immunosuppressants by themselves. This may be your doctor's line of thought.

http://www.medscape.com/viewarticle/560005
July 2007 Drug-Induced Liver Injury
January 2008 Crohn's Ileitis
Currently trying... Enteral Nutrition, Flax Oil, VSL#3, Folic Acid, Vitamin E

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