If you don't use Prometheus, what tests do you have done to determine if you are reaching the concentrations of drugs like 6mp or azathioprine necessary for therapeutic benefit? My standard labs are fine, but my results from Prometheus show I'm not processing the drug well, am at an increased risk for liver toxicity and am not at the level of therapeutic benefit. We've based the decisions to move me off of 6mp to azathioprine off of the Prometheus results. Now we're making the decision to move from azathioprine to an infusion (hopefully vedo, but likely Remicade).
From my knowledge, Prometheus is not *necessary*. You don't need to check therapeutic concentrations of these drugs. There is a fixed dose of these drugs and one should not go beyond that. Forgot the dose now, should be there in my older posts somewhere.
If you are not processing these drugs, you liver function will be markedly off and that is an indication to either lower the dose and stop cold turkey.
When I started Azathioprine, I wasn't even living in the US. All my Swedish GI did was to check my liver function every time before raising the dose, i.e. every 2 weeks. All well, go ahead, not well wait for 2 more weeks. Once I reached the dose necessary, 150mg, he checked function for 3 months, each months and then every 3 months. All went well, no worries at all.