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Your concern while quite understandable is ill founded
There is little evidence that Remicade or 6mp increase the chances of this by any sizeable percentage.
In fact there are many UC / IBD patients who are on BOTH these medications too with prolonged remission
No long term study has conclusively proven the link of increased lymphoma,
and most doctors (just like yours) are very comfortable using these drugs without a waiting period, since this can be detrimental to the child's health
especially in a case such as yours, where control is very difficult to achieve
However, there is a disclaimer for Remicade that states that there is a certain group of young males who contracted a lethal lymphoma. The only ones that got this lymphoma were young males who were on both Remicade and 6 MP. All I want to know is how long you would have to be off of the 6MP for this not to pose a risk of this specific lymphoma. How long would it take for the 6MP to be out of your body?
Yes, the risk was in fact investigated by FDA too, and no significant change of usage was suggested
Unfortunately, that does not answer my question.
Is there a quantitative answer available?
According to my drug reference, the half-life of 6 mercaptopurine is very short - on the order of hours.
Will you be able to tell me shortly?
The half life is around 60-120 minutes onlu
Hence a wash off period of days to weeks would suffice in this situation
Sorry for the delay, needed to check the exact time of the half life of the drug
OK, thanks. So, the way I understand it is that even though the risk is very minimal, do you think that the only patients who died from that specific lymphoma were young males who were taking the medications concurrently--NOT spaced at all apart? So, if we waited a few weeks in between the 6MP and the Remicade, although there would be associated risks with taking Remicade, there would be no risk of the lethal lymphoma from taking both drugs?
The fact of the matter is..
1. The risk of increased lymphoma are NOT quantified in any study
2. FDA has not found any need to change the recommendation of medicine usage on the basis of its investigation in 2008
3. The risk is probably related to immunosuppresion per se, which would be more when a large number of immunomodulators are used.
4. The risk will be very minimal, and a wash out period may not make any significant clinical difference to the same
I would like to NOT wait in this situation since the risk of stopping therapy is far greater in this situation as compared to the essentially theoretical long term concern of lymphoma
Thank you--you have helped with a difficult question.