Posted 10/9/2015 7:49 AM (GMT -7)
What would you do?
I’ve been in symptomatic remission for a year now and my gastroenterologist is suggesting I eliminate 6mp and rely just on Remicade. A little backstory: I had added 6mp prior to the Remicade during a nasty flare, and 6mp couldn't pull me out itself. He wants me to drop 6mp for several reasons:
First, I have been slightly neutropenic (meaning low white blood cell count). The likely cause is the 6mp. Normal is 3.8 or greater, my WBC values in various tests since June are: 3.3, 3.5, 3.2, 3.6 and 3.5 (last two jumped after dropping from 75mgs to 50mgs daily of 6mp in August). Given, I am just barely out of range, not in the scary territory of really worrying about sepsis or other dangerous infections occurring (which is values in the 1, 2-ish kinda range) with my current WBC results.
Second, I have been on 6mp for over 2 years, the time in which he wishes to get his patients off of immunosuppressants due to concern about melanoma (skin cancer) over long term use. Basically, if their use is no longer necessary then get patients off of it to eliminate the chance of additional side effects occurring. And as a plus, it would mean no more trimonthly blood tests (if off 6mp).
Certainly, I don’t want to be on more medications than is necessary and reducing long-term risk seems like a good idea.
The question of antibodies to Remicade without the 6mp comes up in my mind. It worries me a little bit. As now, I’ve got no fade in response at all, between Remicade infusions. Generally, starting Remicade and 6mp concurrently produces the smallest odds of developing antibodies. Whether it’s essential to continue the 6mp to prevent antibodies indefinitely, I haven’t seen stated/studied. Certainly, the initial entry of a foreign material into the blood stream is when it is most likely to trigger an immune response and develop antibodies.
He wants to run a series of tests before proceeding and verifying it is safe: Prometheus Ansr IFX to check for Remicade concentrations before my next infusion and check for antibodies, and do a sigmoidoscopy and verify I am in endoscopic remission. If those tests come back fine, he’d feel safe in recommending I get off 6mp. If I go forward with the tests, then either I agree and want to proceed with dropping 6mp, or would at least glean some information from those tests (I haven't had a scope done in a couple years, never had antibody levels checked).
I'm pretty much wavering, back and forth between one choice and the other (stay the course, or eliminate 6mp). What'd you do?