Today, an anxious mother inquired about the recurrence of her child’s disease with Crohn’s disease, and although I replied, I was always a little blocked in my mind.
Why?
Because this mother said that her child was diagnosed with Crohn’s disease and was also hospitalized in a regulated hospital, and his condition was stable after hormone and azathioprine treatment. However, after her child was discharged from the hospital, she read something on the Internet and thought that azathioprine was very toxic, so she stopped using it on her own for several months. This led directly to a reoccurrence of the disease this time.
I, for one, really need to say a few words for azathioprine.
A few words of defense for azathioprine. Because, too many patients misunderstand it.
First of all, azathioprine is an immunosuppressant and is one of the most important drugs in the treatment of Crohn’s disease. Azathioprine is the first and most commonly used drug for maintenance (i.e., to prevent relapse after disease control). For lifelong chronic disease, relapse prevention is the biggest learning curve when it comes to maintenance medication. I have repeatedly emphasized this point in my lectures to doctors: A gentleman does not treat the disease before it occurs. In fact, it means that the prevention of relapse is the greatest learning of an IBD specialist. The most important drug for relapse prevention is this class of drugs – immunosuppressive drugs such as azathioprine!
Secondly, azathioprine does have many side effects, the most common being leukopenia and liver function impairment. Other side effects include rash, flu-like symptoms, and acute pancreatitis. However, the vast majority of side effects can be controlled, and as long as they are followed up properly by an experienced specialist, there are basically no major problems. Once side effects are detected in a timely manner, they can basically be improved after stopping the drug. There is no need to be afraid of azathioprine.
Also, the side effects of azathioprine often occur in the first 2 months of taking the drug, while it takes basically 2 – 3 months for the drug to take effect. This paradox is what makes many patients reluctant to use the drug. As a result, many patients feel only some side effects of the drug in the early stages of taking it and do not experience any of its benefits at all. For this point, I hope you can stick to it, because Crohn’s disease is a lifelong chronic disease, and long-term use of hormone-like drugs can produce serious side effects if not maintained by good medication. As long as it is tolerated and adhered to, you will slowly see the effectiveness of maintenance drugs like azathioprine. Many of my older patients have experienced this and I hope that newer patients will communicate more with their older patients if they have the opportunity to do so. Many of my outpatients have repeatedly mentioned to me that their symptoms have improved significantly with adherence to azathioprine and that relapses have decreased significantly.
Finally, I would also like to clarify that it is not enough for patients with Crohn’s disease to feel good about themselves, because many times the disease progresses quietly. If we use the analogy of an exam score of 100 out of 100 meaning that self-perception is only 60, we hope that the patient can reach 90, which means that the mucosa has healed endoscopically. Because a lot of literature and clinical experience shows that only when the mucosa heals (that is, when the original ulcer, etc., heals under endoscopy), the number of procedures can be effectively reduced, the prognosis can be improved, and the quality of life can be enhanced. Drugs such as azathioprine are the ones that can improve the probability of mucosal healing.
Of course, azathioprine is not the only drug to prevent recurrence, and a small number of patients cannot tolerate it and have to be maintained with other drugs. These are all things that our specialist physicians need to individualize according to the actual condition and constitution of the patient.
In the long journey of treating Crohn’s disease, drugs like azathioprine are often the most important weapons! Please do not stop taking your medication at will!