Imuran & Pancreatitis

[NicShaf]

So, I had the TPMT test done to test my tolerance for Imuran a couple weeks ago. Got the results back, and they are in the middle of the field...I'm not high risk of developing complications, but not low risk either.

The complication that worries me (and my Dr.) is Pancreatitis. He said he has only seen 2 cases in 30 years of using Imuran, and they didn't do the TPMT test before about 3 years ago.

So my question is, what would you do? My choices are Imuran or MTX. Imuran seems like a milder medication from what I've read, but acute pancreatitis is a serious condition.

Any thoughts?

[Al]

So, I had the TPMT test done to test my tolerance for Imuran a couple weeks ago. Got the results back, and they are in the middle of the field...I'm not high risk of developing complications, but not low risk either.

The complication that worries me (and my Dr.) is Pancreatitis. He said he has only seen 2 cases in 30 years of using Imuran, and they didn't do the TPMT test before about 3 years ago.
So my question is, what would you do? My choices are Imuran or MTX. Imuran seems like a milder medication from what I've read, but acute pancreatitis is a serious condition.

So, Nicole, it is true that pancreatitis is a known side effect of AZA, though a rare one. The TPMT test can, supposedly, narrow down the risks even further. Even so, many Imuran users have digestive "anomalies", like nausea. MTX has its own toxicities, however, and should not be used where there is little kidney reserve. (In cases where Imuran is not well tolerated, and methotrexate is contraindicated, the choice is almost always CellCept (MMF). One way to decide is to start on a lower dose of AZA, and check liver enzymes regularly for a while.

Al

[NicShaf]

Thanks Al. I know it is a rare side effect of AZA, but still a little scary. But AZA seemed like a better fit for me in other respects. I had lung involvement, which MTX warns about. Also, I haven't had children yet, and if I wish to try for a child a couple years down the line, AZA is milder in that respect also.
I have heard that both AZA and MTX can be a little hard on the stomach, so that wasn't a factor in my decision.

[Palmyra]

Hey there NicShaf!

I have been waiting for this question for years, as my daughter was one of the few unlucky one's that developed acute pancreatitis after 3 weeks of Imuran treatment (at that time it was prescribed to maintain remission for her primary Crohn's disease). The drug worked immediate wonders to control her Crohn's symptoms, but she was one of the unlucky few that developed acute pancreatitis after three weeks of use. Her symptoms were intense, required immediate ER and inpatient care, and the treatment to correct the pancreatic damage was invasive (they had to install multiple pancreatic stents via ERCP procedure, and she had to take pancreatic enzymes with a low fat diet for ~ six months. She has had similar problems with other AZA drugs. She has had no such issues with methotrexate. These RX side effects are so very individual, it might be impossible to predict what complication you might or might not expect after taking any of these drugs (?)

She already had a granulomatotous disease of her GI tract (Crohn's), that likely involved the biliary tree. Imuran may have simply pushed her over the top. The sad news was that she initially responded very positively to Imuran, but sadly developed pancreatic problems some weeks later. It took months for her to recover, and I am sure she suffered some permanent pancreatic damage as a result. She had two ERCP procedures to open pancreatic ducts, and was on a fat restricted diet for several months, coupled with pancreatic enzymes to compensate.

Do remember, this is one experience out of many, and that she had GI involvement prior to this treatment. I see online that many have a very positive result with Imuran therapy.

Yours,
Jane Taylor Freudenfeld, mom to Alison, Crohn's '99, Weg '06

[Al]

Thanks for the first (or second) person report, Jane. I am supposing that Allison started with Imuran before the TPMT test became widely used...? TPMT is designed to tell if the proposed user actually produces the thiopurine methyltransferase enzyme necessary to process the AZA. Hence, the results should say fairly precisely who is at the most risk for potentially toxic side effects.

One quick note about "side effects": This term is used in a statistical basis. Trouble is, actual humans are not exactly statistics. If you are one of the few on the wrong side of the numbers, it is a direct hit, not a side effect.

Al

[Sangye]

Nicole, I am a big believer in going with your gut instinct. It's a toss up between mtx and imuran. Mtx has its risks, too. I developed the not-so-rare pneumonitis from it and it wreaked havoc on my already messed up lungs.

If you have a feeling that mtx would be milder on you then I say go with it.