Thursday, May 5, 2011

Why 5-ASA is History

I have dedicated this blog thus far to my experiences in the last 5 weeks and to the panproctocolectomy surgery. While this period of time has certainly been a challenge, it has been just a small jigsaw in a much larger puzzle. Since I have been on approximately 5 different classes of drug treatments over the last 9 years, I would like to dedicate my next 5 blog entries to discussion of my experiences with each of them.

I was first diagnosed with Ulcerative Colitis via colonoscopy in 2002 by my pediatric gastroenterologist, Dr. Markowitz at North Shore University Hospital. I was very sick at the time of my diagnosis and so I was put on 60 mg. of Prednisone (a corticosteroid) and was also prescribed Asacol, a 5-ASA or mesalamine drug. I would take 16 Asacol pills daily (4 pills, 4 times a day), though thanks to the CCFA and strides made in the field of research, Asacol was recently condensed and is now given as 1 pill, once per day. I was also given prescription Iron to treat my anemia and a prescribed form of Folic Acid as Ulcerative Colitis patients are known to have chronically-low Folic Acid levels.

Thanks to Prednisone, I was able to achieve remission from U.C. within two weeks of my diagnosis, although I had lost 20 pounds and was very weak so it took quite a bit longer to gain my strength back. I was slowly weaned off of the Prednisone over a period of 4 months and felt well for that length of time. Unfortunately, once I was off the Prednisone, the Asacol was unable to keep me in remission on its own and so my doctor added Colazal (Balzalazide), another 5-ASA agent to my regimen. This added another 10 pills daily, and I believe at this point I was up to around 31 pills/day. The Colazal didn't work. Instead of taking me off of the 5-ASA agents, another drug was added. At this point (about 8 months after my diagnosis) I was given 6MP (mercaptopurine), a drug used more often in the treatment of leukemia that required biweekly blood tests to assure my white blood cell count remained in a healthy range. As an important side note, Ulcerative Colitis is an autoimmune disease, meaning your immune system attacks itself. Therefore, the treatment for Ulcerative Colitis necessarily requires the suppression of your immune system, and so these treatments lower your white blood cell count and inhibit your body's natural ability to fight off infections. I was able to achieve intermittent remission with 6MP, but was left on the 5-ASA agents for 3 years.

During a routine visit to my gastroenterologist in Maine while I was in college, my doctor found high amounts of protein in my urine which is symptomatic of compromised kidney function. I was immediately sent to a nephrologist who deduced that the damage done to my kidneys was caused by the 5-ASA agents. Now, I must explain that this is a rare complication of 5-ASA drugs, though it does happen. 5-ASA are the most mild and least risky treatments used for U.C. and those that are able to obtain remission on 5-ASA agents with no serious side effects are very lucky.

For me, 5-ASA agents were eternally taken off the radar. I was no longer a candidate for them, but because of their very limited efficacy in treatment of my U.C., I did not find this news to be particularly troublesome. I was now onto a cocktail of 6MP and high doses of Prednisone (the Prednisone was taken sporadically, but I spent more time on them than off).

In conclusion, 5-ASA drugs are relatively harmless in comparison to other U.C. treatment options and if they work for you...stick with them!

And, oh, I turned those pictures around from yesterday as I know it was irking some of you!

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