6-Mercaptopurine and getting pregnant

[Jen__0__0]

  I wrote in Sept. concerning the use of 6-mercaptopurine by
  fathers and associated risks with getting pregnant.  Thank
  you for your response.  I now have some follow-up questions.
  First some background:  My husband has been taking 6-mercaptopurine
  since June, 1998 to control his ulcerative colitis.  He had been
  on and off prednisone for nearly 2 years, so his doctor switched
  him to the 6MP as a way of keeping him off steroids.
  My husband has had UC for 7 years but the last 2 years he has been
  in near constant flare-ups.  The 6MP worked until late Dec. 1998
  when he started to go back into a flare.  It became severe and
  his doctor put him back on the prednisone (30 mg/day).
  Because my husband and I want to start trying to get pregnant, he opted to go off the
  6MP when the flare started(since it hadn't worked to keep him out of the flare
  and since he was back on the prednisone). My husband's condition
  did not immediately respond to the prednisone (as it always has in the past),
  so the doctor told him to go back on the 6MP and he upped his
  prednisone dosage to 60 mg (he is also taking daily sulfasalazine
  by mouth and he began taking daily steroid enemas).  Since March 1
  my husband has been asymptomatic (low frequency, no urgency, firm
  stools, and no blood).  He is tapering off the prednisone (at 40
  mg currently) and he has stopped the enemas.  He is still taking
  6MP and sulfasalizine.  We still want to have him off the 6MP
  for at least 3 months so that we can start trying to get pregnant,
  but we want to know the best way to do that.  My husband's doctor
  seems to think he should just stay on the 6MP indefinitely, but that
  will not allow us to get pregnant.
  My questions are:
  1) Are there many people with ulcerative colitis using 6MP?  
  2) What is the evidence that supports its use?
  3) What do other people do when they want to get pregnant?  
  Since my husband went into a flare on the medication, we don't have
  any evidence that it's working. The doctor says we don't
  have evidence that it's not.  Both are true.  Why can't he try
  to go off the 6MP and if symptoms recur then go back on?  It seems to make
  more sense to go off it now while he's still on the prednisone as back up.
  4) Do patients develop a physical dependency on 6MP and is there evidence
  for rebound when the patient stops taking the drug?  Does the immune system get used to having the 6MP suppress it,
  so that when the 6MP is removed, the immune system becomes even more
  active.  In other words, by using 6MP is my husband setting himself
  for having to be on this drug forever?
  5) If my husband is not experiencing symptoms currently, is there
  any data showing that he NEEDS to stay on the 6MP or can he go off
  until symptoms recur?
  I realize I have asked a lot of questions, but it
  is so difficult to reach our doctor or to have time with him to
  ask detailed questions.  We do not want to jeopardize
  my husband's health but we also don't want to wait indefinitely
  to get pregnent while he is taking medication that we don't even know
  is working.
  My husband and I both have strong biology backgrounds and we'd
  like to know all the facts and all the data.  We want to know how
  to start trying to get pregnant as soon as possible and as safely as
  possible.  Any and all information you can provide will be
  helpful.
  Thank you,
  Jen

[HFHSM.D.-rf]

_
Dear Jen,
You have ask ed a number of important questions that I will attempt to answer.
1)The use of immunosuppressve regimens (excluding corticosteroids) is a recent development in the therapy for ulcerative colitis.  Many physicians feel that the risks of immunosuppressive treatment out weigh the benefits in view of the fact that ulcerative colitis is curable with surgery (whether patients feel the same way is a different question for which the answer is not known).
2)I am unaware of a physical dependency to 6 MP or a rebound effect in the symptosm of ulcerative colitis.  Unfortunately, the next steps are those of trial and error.  When your husband is asymptomatic, the 6 MP should be stopped.
Best of luck.
This information is presented for educational purposes.  ASk specific questions to you rpersona;l physician.
HFHSM.D.-rf
*keywords: ulcerative colitis
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