infliximab and azathioprine risk

Remicade and azathiopurine are a common combination used over the last 20 years. I was on remicade and 6-mercaptopurine together for about 6 years without issues or side effects.

I too was initially worried about starting immunosuppressive meds and combinations of them. What helped me greatly was looking at the actual risks versus benefits. The most concerning side effect of immunosuppressive medications is lymphoma which has odds of 4 in 10,000 (or 0.04 percent) for immunosuppressive mono-therapy, compared to 2 in 10,000 (or 0.02 percent) for the general population. If you're concurrently on a thiopurine and biologic then the odds are 6 in 10,000 (or 0.06 percent). What happens to those who ultimately get the lymphoma? 66 percent are able to put that into a remission and are fine thereafter. So there's small odds of this happening, not something to loose a lot of sleep over.

What's the origin of the lymphoma and IBD med warnings? During the initial clinical trials of remicade, two adolescent men got the lymphoma. Those patients were concurrently on a thiopurine (azathiopurine, imuran or 6-mercaptopurine) and remicade during the clinical trials. Thiopurines have a known history of lymphomas. Nobody got the lymphoma on remicade mono-therapy during the clinical therapy.

One thing you can do, is plan on taking the Azathiopurine until a remission is sustained and then discontinue aza only to reduce your risks. As it takes a lot more meds to initially achieve a remission than to sustain it.

A good read on it:

https://www.crohnscolitisfoundation.org/sites/default/files/legacy/assets/pdfs/risk-and-benefits-transcript.pdf

I would not worry. Healing isn't a linear line from flare to remission with daily progress. Rather it's more like a rollercoaster ride full of surprise rises and sharp drops. Look at week-to-week progress, as there's too much random variation bm-to-bm or day-to-day.

Hang in there, I know we're an anxious bunch, present party included.