11-04-2015, 04:02 PM   #1
EmmyMichelleG's Avatar
Join Date: Nov 2015
Location: Thousand Oaks, California
6mp vs Remicade

Hey guys. I'm a newbie here ( to the forum and the world of Crohn's medications) with a bit of a dilemma.

I'm currently trying to recover from my first flare up I've experienced since being diagnosed 3 years ago. My CT showed increased inflammation and we are trying to figure out a course of treatment. I have a scheduled colonoscopy next week should hopefully bring forth more results. I don't really understand much of what's happening right now anyway.

I moved states last year and have just began working with a new GI. His course of treatment recommends 30mg of prednisone for 2 months and then afterward starting 50 mgs of 6mp. Both of these drugs and their side effects are very, very concerning to me. I'm a competitive equestrian and need my energy to ride my horses and compete to the best of my abilities. I'm campaigning my horse to make international teams and cannot afford to have my energy levels compromised by 6mp...to my understanding the side effects are similar to that of a chemotherapy patient. I've had to watch my father go thru it twice now, and it's not something I wish on anybody. I work in high end sales and interact with people on a daily basis, as well as do promotional work for vendors outside of my regular job. I'm in the public eye a bit, and everything about prednisone seems to diminish your appearance and overall state of being. I have a history of depression, mood swings, insomnia and severe anxiety. It basically sounds like prednisone is going to turn me into a monster.

This being said and after me explaining this to my doctor, why would he want to put me on something that will only make me feel worse? I understand the severity of my condition but with modern medicine and technology, why wouldn't I be able to be on something like Remicade or Humira? He mentioned it but didn't seem to stand behind it too much.

The limited research I've done on the 2 drugs leads me to believe that it could be a better treatment option for me. My old GI is also on the case and is hesitant to start me on invasive steroid treatments based on my history and lifestyle. People who are on Remicade seem to love it, virtually no side effects and go into remission quicker and with less pain. What do you guys think would be a better treatment option for me?

I should know more after my colonoscopy,which will be carefully reviewed by both doctors. But for now I'm very confused and pretty scared....
11-04-2015, 05:23 PM   #2
Forum Monitor
Clash's Avatar
There are a number of people here on 6mp. Some do feel nauseated and fatigued the day of medication or for a short while afterward. Most often times that is until your body adjusts. I wouldn't necessarily compare it to what a cancer patient goes through with the level of doses they have to take, though. There are a number of patients that are on 6mp that after the first couple weeks or from time staring have no side effects.

Pred can have side effects like moonface, acne and such. It is mainly a rescue drug and used to quell the inflammation while the maintenance med like 6mp has time to build up to therapeutic levels. For this reason, the maintenance med is generally started while on the pred in hopes that it has reached optimal efficacy by the time the pred is tapered off.

As far as remicade or humira, there are two thought processes at play with CD treatment. For the longest, the treatment model favored by most GIs was bottom up approach. So if the meds were lined up as a pyramid, you would start with the lowest level of the pyramid and work your way up the levels as a med failed. So imuran, 6mp or methotrexate would be tried before biologics. Some GIs now favor the top down approach start with a biologic and add lower level meds if needed. The thing with biologics is once you stop one you run a high risk of building up antibodies to it and therefore cannot use it again. So basically if you go the biologic route it's there until it stops working because even if you reach remission coming off of it will run the risk of creating antibodies and eliminating it as a med you can use in the future. This doesn't happen for everyone on biologics but it is quite common.

Pred would be used with either of these treatment strategies to quell the inflammation while the med or biologic reached therapeutic levels. Another option other than pred is EEN exclusive elemental nutrition. Which is basically a formula only diet or sometimes 90% formula 10%certain foods for anywhere from 6 to 8 weeks. There are no side effects, some people drink the formula others like my son place an ng tube each night and the formulas goes in while asleep and they remove the tube in the morning.

If you aren't happy with your treatment mention to your doctor that you are interested in biologics. They have side effects too, not always common but can cause fatigue, joint pain sometimes psoriasis and such. A second opinion from another GI and his treatment option for you might also be helpful.
Mom to
C age 19
dx March 2012 CD

CURRENT MEDS: MTX injections, Stelara

Dx May 2014: JSpA
8/2014 ileocecectomy
9/2017 G tube

PAST MEDS: remicade, oral mtx, humira
11-05-2015, 08:06 AM   #3
Lady Organic
Forum Monitor
Lady Organic's Avatar
all drugs come with possible side effects, and this stands also for both Humira and Remicade. Elemental liquid diet is the safest alternative you can try to induce remission, but not all adult doctors are comfortable with it and use it. so you'd probably have to make some research on your own to convince your doctor. plenty of info on the forum about it.

Biologics are normally reserved to moderate to severe cases or patients refractory to immuno-supressants. Insurance will often want that the patient have tried and failed Immuno-supressants (6-mp/aza and or methotrexate) before accepting to cover biologics. Biologics are very expensive drugs compared to all the others so this is the first reason. Biologics require infusion in a medical center or self-injections, which is different than 6-mp, which is a daily pill.
''UC-like Crohn's'' since 2001:
on: 25mg 6-MP (purinethol)+ B12 shots
minor hands/wrists chronic arthritis since 01/2013

Diet: ''IBD-AID'' : http://www.nutritionj.com/content/13/1/5+ organic food only
suppl Curcuminoid extract, Inulin,psyllium, apple pectin, Vitamin D

past meds:
pred 50mg, 5-ASA, cortifoam, Imuran (failed) Purinethol (success) methotrexate (failed CD and arthritis).
11-05-2015, 11:52 AM   #4
Senior Member
nitty's Avatar
Join Date: Dec 2011
Location: United Kingdom

My Support Groups:
Try not to focus too much on the possible side-effects as not everyone gets them. Bear in mind that most of the time people are posting on forums like this because they are having some problems, but there is a whole host of others out there happily getting on with things because they do feel better on their meds.

I felt much better once I started Prednisolone as it was the one thing to get my flare under control. I had a few problems with other mezavant and decided to come off it, but now I am struggling to get out of the flare that resulted!

Remember that the disease itself can have much worse outcomes if left uncontrolled.
12-30-2015, 02:07 AM   #5
Senior Member
tots's Avatar
Join Date: Feb 2012
Location: Austin, Texas

My Support Groups:

I am from Thousand Oaks, I sure miss the area. I had a great Dr there, Dr Gregory Johnson.
I have a lot of family members in the medical field in that area and he is very highly recommended.

I hope you enjoy living there! I miss the beaches!!


Diagnosed= 1992 and again Feb 2012 Confirmed with
CT enterography May 2015 !!

Waiting for the ok from my Ins company to restart Remicade. Will also start Imuron to get into remission!
I know it's out there somewhere and I WILL find it!

01-03-2016, 04:45 AM   #6
Catherine's Avatar
Join Date: Jan 2012
Location: Melbourne, Victoria, Australia

My Support Groups:
My daughter is on high dose imuran and has no side effects. She has as less illness while on imuran than before imuran.
Mother of Sarah dx aged 16, Jan 2012
DX - CD 1/12, asthma
Small bowel to small bowel fistula

Meds: ), azathioprine 200mg, Mesalazine 1.2g x 2, seretide 250 x 2 (asthma), ventolin (as needed)

Currently no supplements.

Has previously taken Multi B, Caltrate, B12 & Iron

Prednisolone (from 30 mg 01/02/2012 to 17/06/2012, 30mg 24/10/12-28/12/12, 50mg 24/1/13-27/4/13)

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