Imuran to Biologic even in remission?

I have a friend who was on imuran for 5 years in remission then quit (in consultation with his doctor). He's still in remission as far as I know and it's been another 5 years. I think I recall the odds of flaring again in such circumstances are 50%. But seeing as remicade might not work for him anyway (again, odds around 50%), it seems questionable to just switch to it if not already flaring.

My first GI who I really liked (then he retired) told me that he had a patient on Imuran for 30 years with no issues. Dunno ... get a 3rd opinion?

One more thing .. does your cousin have a very small build? I ask because Imuran is weight based and therapeutic dose for a 100 pound person would be 75 mg -125 mg. If he weighs more than that it's possible Imuran isn't doing a lot for him.

I hate being cynical. I hate, hate, hate it.

But if a doctor told me to stop using the effective, nearly-free generic Azathioprine and switch to a tens-of-thousands-of-dollars a year biologics I would get at least TWO second opinions before doing so.

My old GI who just retired once told me "These pharmaceutical reps, they come to the office to sell the newest drug, they are ALL female, they are ALL straight out of college age, they are ALL top-of-their-class brilliant and they are ALL tens."

Nobody comes by to sell generic Azathioprine.

I would go with the second opinion doctor or ask to stay on it.

I highly doubt they are suggesting the switch for money or because the reps "are all TENS" (can't believe a GI would make such a stupid, sexist comment).