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Imuran vs. Remicade; trying to conceive...

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Posted 4/6/2015 10:01 AM (GMT -7)
I will be having this discussion with my GI at the end of the month, but he has suggested both to me. Reading up on them, they both sound terrifying as far as risks go. Also, I'm trying to conceive and I'm not sure what the best option is. Help!
Posted 4/6/2015 11:34 AM (GMT -7)
Both are safe for pregnancy. Remicade might be the better choice in terms of efficacy and pregnancy management.
Posted 4/6/2015 1:10 PM (GMT -7)
Yes to what Kazbern said. I have 2 & 1/3 Remicade babies (3rd one conceived on remicade, but switched to Humira after first trimester). They are now 11, 8, and 6. Healthy, smart kids. No negative effects from the remicade on the pregnancy and I breastfed all 3 of them while on remicade too.

My #2 was conceived while on remicade and 6mp. Imuran metabolizes into 6mp so they are pretty much the same thing. I didn't continue it throughout the pregnancy because it started to affect my liver. That being said, the studies have shown that women who take imuran/6mp during pregnancy have no greater incidence of problems than women in the general population.

I'm currently taking Imuran and ttc as well. I'm not sure you can breastfeed while taking it. That is more risky than the remicade when it comes to breast milk.

I would say that either would be ok, but you should go with the one you feel the most comfortable with. And... You should go with the one that does the best job of keeping you in remission. Inflammation and/or a flare up is far more dangerous to a pregnancy than those meds. Don't panic too much about what you read... They have to cover their butts and list all possibilities, but it doesn't mean it will happen to you!

Stef
Posted 4/6/2015 1:22 PM (GMT -7)
I was on Imuran until it caused my pancreatitis, so we switched to Remicade. I was on Remicade my entire pregnancy and my daughter is doing GREAT. For the first 2 months we kept her inside at all times and away from people so that if there was any leftover Remicade, it would get fully out of her system. And no live vaccines until she was a year old. But other than that, we were fine. We tried to time the infusions so that the last one would be around 32 weeks and then get the next one right after she was born. It ended up at 29 weeks and then my c-section was at 37 weeks so I got the infusion the day after the c-section while still in the hospital. It was also fine with breastfeeding.

As it gets closer and you do get pregnant, come back and ask some more. :) I don't want to overwhelm you with all of my lovely, bossy advice right now. ;)
Posted 4/6/2015 6:44 PM (GMT -7)
Thanks everyone. My concerns are obviously I don't want to compromise a pregnancy, but also reading about the increased risk of infections and cancer... those disclaimers are really scary! In the event that I do become pregnant, I want both the baby and myself to be safe. But I want to get better too....
Posted 4/6/2015 7:15 PM (GMT -7)
Any doctor will tell you (and Crohn's patient) that it is much, much better to be in remission while pregnant than to flare. So here's what disclaimers say: "this will double or triple your cancer risk!" Since in reality, the risk is only 1% for a healthy person, then it only goes up to 2% or 3%. Does that make sense?

When I was pregnant, I was on Remicade infusions. I had really, really bad hyperemesis the whole pregnancy and started getting dehydrated really bad around 8 weeks. This made my Crohn's start flaring and going crazy, which meant I had to get put on prednisone. Prednisone is not very good for developing babies because it interferes with how their bodies will develop and produce their own hormones. (It is given to preemies because at the end of pregnancy it can help lungs develop faster.)

After we got the flare under control, I started flaring again because of dehydration. The doctors said that if I kept flaring, I would most likely miscarry. I ended up having to get IV fluids every single day for most of the pregnancy, but it meant that Remicade was able to work and I didn't have to be on prednisone.

Putting it this way: the potential risks of Remicade are much lower than the almost-guaranteed risks of flaring and miscarrying or delivering way too early. For me, I would much rather to the Remicade every time.
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