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Xeljanz vs Imuran

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Ulcerative Colitis
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Posted 10/8/2019 3:57 PM (GMT -5)
Hi everyone, I had a follow up appointment with my GI yesterday and based on my last visit, I thought he might suggest that I should try to taper off of imuran since I've been in remission for a few years. However, he said 'If it ain't broke, don't fix it' and since things are going well to just make sure I get a full body skin check done, flu shots, etc.

I was giving an update on my current status to the doctors nurse before he came in and shared his thoughts - she did mention alternate meds like Humira, Remicade, Xeljanz. I was curious about Xeljanz and was wondering if anyone here has gone from Imuran to Xeljanz and what their experience was like. Is Xeljanz considered a 'safer' drug compared to Imuran? I know they all have some risk but before yesterday I wasn't even aware of this drug.
Posted 10/8/2019 5:41 PM (GMT -5)
Still on 75mg of imuran? Typical dosing of it is close to your body weight (in pounds). So 75mg is low except for very small people.

Have you had blood tests done to see whether or not you are in the therapeutic range for imuran metabolites?

As for xeljanz vs. imuran, xeljanz is most likely more effective, and it works faster.

They both have a very real risk of side effects, with it hard to say one is worse than the other. There is a lot more long term data on imuran than there is on xeljanz (because it's relatively new). There is some debate right now about whether xeljanz increases risk of blood clots. More studies are needed to confirm/deny this.

Risk/benefit of either xeljanz or imuran really comes down to the individual patient and their medical history, including family history.
Posted 10/9/2019 6:35 AM (GMT -5)
You’re going to get a lot of different opinions. Even among doctors. I asked my dr recently if I could come off Stelara at some point and he said after 2 more doses he would start lowering my dose, if I still do well then I can come off. Some doctors will say to stay on. Honestly I don’t think anyone knows, my dr said some patients go years without needing anything and as long as they do well and do scopes he’s okay with it. If I flare again he said I’ll go back on it. He also told me know one can answer much on the newer drugs like Stelara and Xeljanz because they are still new, not much long term research. I do know someone who has been off 6MP for years now. It’s really your decision, only you can decide if you want to try lowering it or not. If you really feel that way, tell your dr and if they respect that they’ll agree and monitor you.
Posted 10/9/2019 2:33 PM (GMT -5)
It's a tough one, do not fix what isn't broken, or switch. Any type of immune suppression carries potential risks, whether imuran is safer then a biologic, I do not know. You could say Entyvio might be safer as it is a site-specific immunomodulator, where as everything else is systematic-suppression.

I know thiopurines (azathiopurine/imuran and 6-mercaptopurine) are kind of the boogeymen of the gasteronenteroligy world as of late. Mostly there is worry about the very small risk of skin cancer and lymphomas when you are on those meds for decade(s) as a maintenance treatment. The biologics do not carry those risks. So if I was to wager a guess, that is the underlying reason in which your doctor even mentioned switching at all (even if he/she did not say so directly).
Posted 10/10/2019 1:10 PM (GMT -5)
Thanks all, yes it's so tricky. On one hand, I'm nervous about staying on these meds and on the other, nervous about tapering or changing meds. The doc did mention that there's no guarantee that any of the other meds will work in case we taper and I'm in flare mode or if I just want to try another treatment option. Yes, the doc will respect my decision if I tell him I want to get off of imuran and just take canasa daily but I don't think I'm mentally prepared to face another flare up in case things don't work in my favor. It took me a long time to get to where I'm at now.

beave - yes I'm still on 75mg of imuran. I know they checked the therapeutic range when I was on 100mg but just sent a note to the nurse asking if they checked again in this last round of blood tests that were run earlier this week.

The only -ve thing that came back as a part of the recent tests is that I'm deficient in Vitamin B12 (below the lower end of the normal range). It must have to do with the fact that I don't eat meat and/or maybe because I have IBD.
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