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Xeljanz and prednisone taper

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Ulcerative Colitis
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Posted 8/20/2019 10:57 AM (GMT -6)
I started Xeljanz 5 days ago. I am also tapering off prednisone - 40 mg now down to 30 mg this week. Prednisone does not seem to work at all really. I am still seeing alot of blood and mucous and urgency. My BM's are mostly all blood. I am wondering if Xeljanz alone (once prednisone taper is done) is enough for remission or should I also be put on 6MP or another immunomodulator. It's really the blood that is my issue at the moment. If I could get that under control, I could probably live with the rest of it. Sometimes, I get up or cough and have bloody leakage. It's pretty bad. My GI didn't want to put me on both 6 MP and Xeljanz at the same time. Now I'm questioning it.
Posted 8/20/2019 12:57 PM (GMT -6)
I was taken off Azathioprine (imuran) two weeks before starting Xeljanz. Due to not being able to take both for risk of over immunosuppresion.
That’s when my bleeding really kicked in! Going from occasional bleeding to just like you have described.
Unfortunately it not a good idea to take them together however looking back I wish I’d remained on it whilst Xeljanz had time to kick in.

Just my theory but I feel the Xeljanz hasn’t been powerful enough to pull me out of the flare that stopping Azathioprine brought on.

Sorry if this doesn’t make sense. I’d also slow down the pred taper if possible.

Were you on a 6mp previously?
Posted 8/20/2019 1:37 PM (GMT -6)
I have never been on 6mp or Azathioprine or any type of drug in that class. I wish I had taken it instead of prednisone this time around. Do they work better than prednisone to stop the bleeding?
Posted 8/20/2019 1:51 PM (GMT -6)
6mp/imuran/azathioprine are very, very slow acting meds, typically taking 3-months to work. So, no, they are not a prednisone replacement. And, yes, I have heard those meds are off of the table if you go on xeljanz.

As far as what are prednisone alternatives, you're talking an IV administered med: cyclosporine/tacrolimus IV, or double-dosages of Remicade by IV.

I would not loose hope, yet as you are only 5-days into zeljanz. It is fast acting, 6-weeks or less, so you have a while to go before calling it a success or failure. Hang in there, it does get better.
Posted 8/20/2019 2:01 PM (GMT -6)
Thank you - fingers crossed!
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