6-mp

I have a call into the GI for Bratcat. When she has seen him in the past he has mentioned that if she flares again, he would want to put her on 6-mp. She had a round of prednisone with last year's flare that worked but he said if she flared again it would mean that she is steroid dependent.

We know there are terrible side effects (both short-term and long-term) with steroids but they did work the first time.

And once the drugs (pred, asacol, rowasa) started working, she went into remission (she had a great summer). She doesn't mind taking the asacol and rowasa daily.

What are the good and bad sides to 6-mp? He mentioned that he would use it in conjunction with Entocort (Endocort?) until the 6-mp started working. If she does start the 6-mp, how long could it be until she starts to feel better? She missed 9 weeks of school last year and doesn't want to have that happen again.

It's hard enough admitting that she is in a flare again. She did try to lower her dosage of rowasa. Maybe too much (down to 3x week). But the asacol and daily rowasa seemed to work when she finally got the flare under control with the prednisone.

Thanks for any help, Bennie

 

I took 6mp and it only took a week or two to see vast improvement. However, when my blood was tested a month or two later, I had liver inflammation, so had to stop. I'm on Lialda now, along with entocort and am feeling really good so hopefuly will continue to even after I taper the entocort. I like Lialda, because it is just once a day and easier to remember. Good luck!

Thanks for the feedback. I did speak with the doctor. He wants her to take the hydrocortisone enema in the morning and the rowasa in the evening for the next 3 days. He also wants her to get her bloodwork tomorrow.

He isn't rushing to change her meds yet. He probably will put her on prednisone for a short time (she wasn't on that long before). Hopefully it will jump start her into remission. We just weren't sure if she should start it tomorrow or wait to see if the double dosage of enemas would help.

He does agree that, for the most part, the asacol and rowasa is working. Since this is her first relapse (maybe her last?) the doctor isn't considering her steroid dependent yet.

Here's some more info on immunosuppresants:

IBD is commonly treated with the immunomodulators azathioprine and its metabolite 6-MP.4 The appropriateness of immunosuppressants in the management of IBD was assessed this year using the RAND method.5 The results of this Italian study show that only azathioprine, 6-MP, and methotrexate are appropriate in the treatment of IBD. In addition, cyclosporine A was found to be appropriate only in severe UC after the failure of steroids.

The only drugs able to modify the disease course are azathioprine, 6-MP, and methotrexate.6 However, these drugs have a slow onset of action and are associated with important side effects in some patients, often necessitating the discontinuation of the drug. Moreover, up to 60 percent of patients do not respond to these drugs long-term. Furthermore, serious drug toxicity leads to cessation of therapy in 9 percent to 25 percent of patients, and there is failure to achieve efficacy in approximately 15 percent of cases.7

Data also suggest an approximate fourfold increased risk of lymphoma in IBD patients treated with azathioprine/ 6-MP.4 The increased risk of lymphoma could be a result of the medications, the severity of the underlying disease, or a combination of the two, the researchers concluded.

Nodular regenerative hyperplasia of the liver (NRH) also can develop in IBD patients treated with azathioprine.8 “Clinicians should be aware of this serious complication which may occur with any of the purine analogues (azathioprine, 6-MP, and 6-thioguanine),” according to the researchers who presented four such cases.

 

http://www.endonurse.com/articles/diseases_disorders/589_5c1feat2.html