Imuran & Elevated Liver Enzymes

[SueAnn]

Sigh.... My imuran was upped to 150 mgs at the end of November.  My latest blood work came back and my liver enzymes were elevated for the first time in almost two years.  I am suppose to stay at 150 and make sure to go every month, which I have been since it was upped. 

I know that the elevagtion  is only slight this month, but I think the only reason I am able to work full time and function well is because of the imuran.  I am concerned that it is going to keep going up. I go to the rheumy on Monday for my 3 month appointment. 

Does anyone have any experience with imuran and your liver function being slightly elevated?

SueAnn

[MaryBee7]

Sue Ann, sorry to hear this.  I took myself off of both Imuran and Plaquenil, pending new rheumy appt.   Have had too much gut trouble and was afraid meds were aggravating things.  I was on Imuran about 6 months.  Please keep us posted.

[mshistory]

Sorry, SueAnn  I just got up to 150 mg of Imuran too and I think I'm starting to notice some improvement in all of the joint pain, chest pain, pressure, SOB, skin rashes, etc. FINALLY. I still have rough days but for the first time in a year and a half, I'm feeling like the medication I'm taking is actually doing something. So I know what you mean about worrying whether or not your rheumy will want you to go off of Imuran.

I hope your labs come back better next time and you don't have to reduce your dose.

[Styx]

First and foremost, be careful. I find most rheumatoligists don't understand AZA and most gastros don't understand MTX. Many rheumies will ignore the persistently elevated enzymes because they are accustomed to this with MTX (where it can be considered normal and benign). If you continue to see serial elevations of liver enzymes, stop taking imuran.

Take the rest of this with a grain of salt as the level of evidence isn't super high:

In terms of treating immune-mediated diseases, physicians treating Crohn's disease have by far the most experience with azathioprine. There is an incredible amount of depth in the literature regarding this.

When I use AZA, I constantly teeter on the border between therapeutic response and hepatotoxicity. I eventually lost the battle and changed strategies. I am now using allopurinol to modify the way AZA is metabolized by my body as described in this article: http://www.ncbi.nlm.nih.gov/pubmed/22386736.

Theoretically, I've been able to bypass the hepatotoxicity and also have much higher levels of the active metabolite (thioguinine) in my blood stream. Thus far, it seems to be working out.

However, if you go this route, you and your doctor really need to know what you are doing, and also note that no randomized, controlled trials have been performed with this combination, though there are tons of small-medium trials espousing its efficacy.

I decided to roll the dice and give it a shot. I'll report back in a few months

Another alternative is to switch to CellCept (mycophenolate).

Styx

[SueAnn]

Styx,

Thank you for your reply, I will look into the literature you suggested.    I have still have faith in my rheumy to be knowledgable about when to take me off AZA.

mshistory, I will let you know how it goes.

SueAnn