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Remicade or Imuran?

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Ulcerative Colitis
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Posted 12/2/2008 10:31 AM (GMT -7)

My first posting because I am confused. I have recently gone to see a second opinion for my UC. I have been on prednisone for 9 months and have been tapering off but at 15 mg my symptoms of UC have come back. I also take Lialda 4  times a day. Now my GI wants me to start Remicade. I went for a second opinion yesterday and this GI wants me to try Imuran. I have mild to moderate UC and am confused of what therapy to take. What have been your experiences and what are some of the side effects anyone have been feeling?

 Thanks for the input.

Posted 12/2/2008 12:26 PM (GMT -7)
You will probably get alot of replies over time but one thing to bear in mind is that whereas Imuran can take many months to have any effect at all, Remicade can have some noticable impact within days to weeks. My personal experience is that Imuran did nothing for me at all other than make me tired. I have been on Remicade for over a month and it has helped me get formed stools and stopped bleeding within about a week and a half, and unlike Imuran it does not yet result in any fatigue, but so far I am still struggling to get below the same 15 mg prednisone "wall" as you are stuck at. But it is too early to say if Remicade will not be my saviour. Imuran is used by most docs as a preliminary step before resorting to remicade but I think that is mostly due to its being around much longer. Now that Remicade is starting to get a longer track record (still not yet 10 years though) some GIs are starting to consider it a first line treatment for anyone such as us, having trouble getting off steroids.  Oh, Imuran is dirt cheap like prednisone (hubdreds of dollars a year at most), whereas Remicade is mind-numbingly expensive (tens of thousands of dollars a year)- so those are surely issues for anyone with no or poor insurance.  Most insurance covers Remicade pretty fully though.
Posted 12/2/2008 4:10 PM (GMT -7)
From what I remember, I think the potential side effects of Ramicade are much worse than those of Imuran. That's not to say Imuran doesn't have severe side-effects either. I would try Imuran before going all the way to Remicade. Imuran wasn't working for me so my GI wanted me to switch to Remicade. Luckily, I was able to bring my UC symptoms under control via diet changes, which may work for you.(There are plenty of other threads on anti-fungal diets in this forum, so I won't repeat the same info here.) Best of luck.
Posted 12/2/2008 8:46 PM (GMT -7)
I tried Remicade, and am unable to take it, my doctor put me on Imuran after that, and now take Imuran and Humira at the same time. It works for me.
Posted 12/2/2008 10:14 PM (GMT -7)
Imuran can take longer to work, but it is a much better-studied drug. It's just been around longer--almost three times as long, actually. The side effects are much better described.

But whichever GI left you on prednisone for 9 months is one you might want to be getting away from, in general. Unless there was something else complicating your treatment to account for keeping you on prednisone for that long without trying any kind of steroid-sparing med (like Imuran), s/he is not current in the field.
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