There isn’t enough evidence to definitively say which has a higher risk, but TNF inhibitors probably have less of a risk than mercaptopurine.
Dear Dr. Roach: I am a 67-year-old male in good shape. I have Crohn’s disease and have been taking one tablet of mercaptopurine for the past eight years. This is the only medication I take, and if I eat bland, exercise, and keep stress down, I feel good.
Do you think mercaptopurine causes skin cancer, and if you do, which new prescription would you recommend? I don’t want to change medications if I don’t have to.The situation is complicated because people with Crohn’s disease are at an increased risk for melanoma, even without the effects of drugs that modulate the immune system — like all three of the drugs that you’ve mentioned.
There isn’t enough evidence for me to definitively say which has a higher risk, but it appears that TNF inhibitors probably have less of a risk than mercaptopurine. There are not significant differences between infliximab or adalimumab-atto that I can find. The overall risk, even for mercaptopurine, is low; about one melanoma was found in 400 people who took the drug for 10 years.
Dear Dr. Roach: How can it be that when I weigh myself first thing in the morning, then drink a one-pound cup of coffee , I weigh more than a pound more afterward? It happens pretty much every day and makes no sense. Weight-wise, I must have expelled more than I took in. I use a digital scale that is accurate.It can’t make sense. While gaining and losing weight sometimes seems to defy common sense, nothing breaks the laws of physics.
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