Biologics next when Immunmodulator Azathioprine fails

[Akido]

I have IBD (Colitis) since 2018 and have been on mesalazine, enema with periodic steroids to manage my flare. Lately I tried Azathioprine for 3 weeks (from 1 dosage to 2) but have elevated liver function test ALT and AST more than 4 times acceptable range last week. Prior aza, it always fall within accceptable range.Other side effects with aza include headache, nausea and poor appetite. Doc asked me to stop it immediately and do a blood test in coming week to ensure the liver heal first b4 next step. Anyone with similar exp and how long it takes for the liver to recover back normal?

Doc also suggested biologics next which is very expensive. I also have option of trying out Azathioprine or 6MP again when my liver heal but he discourages this option. Any tot on the cost of treatment and frequency required for patient with moderate IBD stool test about 550. I am active person with daily exercises

Anyone tried other alternative like 6-MP and feel better with lesser side effects? the uncertainty just makes me crazy....sigh

[Graham49]

If you search on Mercaptopurine there are a number of previous posts for 6-MP.

[Akido in reply to Graham49]

👍👍

[SuzyQ67]

Both medications have basically the same side effects. Personally, I would move to a biologic. If you have insurance there are patient assistance programs available to help with co-pays. Many people use this & pay nothing for the medication.

[Akido in reply to SuzyQ67]

Thanks for sharing much appreciated. r u having biologics alone without azathioprine? It will be useful to share an estimate cost , frequency of dosage n how long it took u go into remission

[saj12]

Whilst I was on azathioprine 125mg dose, my liver function tests also showed elevated reading - I was put onto combination with allopurinol which allowed azathioprine dose reduction to 37.5mg - long story short was on this for about a year - now moved onto biologics - am much better on this new treatment

[Akido in reply to saj12]

Thanks ,. r u having biologics alone without azathioprine? It will be useful to share an estimate cost , frequency of dosage n how long it took u go into remission

[saj12 in reply to Akido]

Hi, biologics on their own - I had significant concern over the possible side effects of a Aza/Biologics combo (If I remember my conversations with the nurses - is age related, higher <40).. so I did come of azathioprine then start.160mg loading does (4 injections of Amgevita)... dropping to a dose of 40mg (1 injection/2 weeks). Fecal calpropectin prior starting was >2000. After 4 months, 550, after 11 months, 49 - have now been on for 13months.

Cost wise, thankfully here in the UK, the costs are covered by our health service.

[Akido in reply to saj12]

Cool & keep up e positive 👍💪

[Eixor57]

Biologics alone. 👍

[Akido in reply to Eixor57]

👌👍