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Does Imuran Slow Disease Progression?

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Crohn's Disease
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Posted 9/19/2007 11:32 PM (GMT -7)
I know studies are inconclusive, but I was wondering if you all thought that Imuran/Methotrexate and such might actually slow down the progression of Crohn's directly. I know that drugs like the 5-ASAs, Prednisone, and Remicade just block a step in the inflammatory process so its doubtful that they have any direct effect in slowing the progression (aside from preventing inflammation and thus damage and therefore making the disease easier to treat). That makes sense to me.

But since Imuran kills off T-Cells, it seems like it might have a shot at reducing the immune systems "exposure" to whatever it is that its attacking. So at least with Imuran there is a shot... and its already been proven to slow disease progression in RA, whereas prednisone obviously does not and I'm pretty sure biologics don't slow it down either.

Just curious about what you guys thought... I'm wondering if I should just go ahead and bite the Imuran bullet, especially if this is the case.

Posted 9/20/2007 6:02 AM (GMT -7)

Good question Styx.  I'm on the Imuran and my train of thought is much the same as yours.  Maybe we'll both get an answer to your question.

Posted 9/20/2007 6:50 AM (GMT -7)
Hi Styx,
Same question here. Why my son's G.I. keeps pushing for it and when we questionned him about the benefits of it, his answer was "As a physician, that is my advice to you!" I often think of finding another G.I., but the problem is he is a Crohn's specialist and he practices in a very reputable hospital in Montreal and he is know from every G.I. in town and they all say, he is the best at what he is doing! So I feel like we are kind of stucked with him. So I will check the answers you get and maybe I could get a little more infos. from it. It is scary to move to the immuno-suppresant drugs and I don't want to do it unless we really have to and I hope we don't and Pentasa does the job for him. I wish you all the best and I hope that you get the answers you are looking for and make a better informed decision.
Good Luck!
Posted 9/20/2007 7:10 AM (GMT -7)
Hello, I have been on Imuran for about 4 months. However, while I was on it, my disease still progressed. I formed more fistulas while I was on it, and the abscesses that I had got worse. I had surgery about 7 weeks ago, and after that, they increased my dose by 50% to 150 mg. I may be different though, because they have done metabolite testing on me to see if I am actually metabolizing the Imuran at helpful levels and those have shown that I am not. I will probably be switching to Humira soon. The immunosuppressive drugs are scary. On Imuran I got bronchitis once and the doctors didn't hesitate to give me anitbiotics to clear it up, but other than that, it hasn't been as bad as I thought. (I am careful with hand-washing and it has been the summer, not the cold-flu season) I think I worry more than I should though. I don't think that Imuran is quite as immunosuppressive as Humira, so if it works for you, that would be great. I would suggest having the metabolite testing done though to see if it is actually working or not after about 6-7 weeks.
Posted 9/20/2007 12:17 PM (GMT -7)

The answer to your question is yes, Imuran does slow disease progression and is known to alter long-term disease progression -- in some people, but not all.  It doesn't *stop* disease progression, and it doesn't help everyone.  But studies have shown that, statistically speaking, it is beneficial in slowing the onset of complications requiring surgery, compared to any other meds available.

The analogy to its use in RA is right on the money.

I would also add that Remicade/Humira are also capable of slowing disease progression and not just masking symptoms (like prednisone) - at least in the short term (<5 years).  Long term studies of course are still ongoing, so not as much is known about their ability to alter the long-term progression of the disease.

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