Is combination therapy still relevant?

By Daughter has done pretty well over the last 10 years on Remicade and Imuran. At the time that she started this combination, the school of thought was that an additonal immuno would assist in preventing antibodies to an anti-TNF.

Prior to Remicade, she was on Imuran exclusively for about 2 years, but never felt like she did well on it, and felt some annoying unpleasant side effects.

After a consult with her GI today, she decided to take her off of Imuran altogether now. She really didn't mention anything to her about antibodies, just that she felt she would continue to do fine on Remicade alone.

Anyone have any input on this, or thriving on just an anti-TNF without any other meds?

I am still on Remicade and Methotrexate. 6 years. No antibodies as long as I take the MX. I have begged to be taken off the MX but GI said no. He thinks you need the dual therapy to ensure you do not build antibodies. I actually shopped my GIs answer with 2 other GIs and they both recommended I stay on dual therapy.

A lady in one of my support groups with Crohns disease stopped taking her MX and continued with her Remicade infusions. Last week she ended up in the hospital due to a reaction during her infusion.

But....if you are younger, haven't had any issues.....you may be able to do it. Another lady in our support group stopped her dual therapy over 10 years ago...and she's still taking Remicade and its working.

So I am unsure.

Has your daughter had any tests to show antibody levels? Is that something they can do to monitor it? I don't know if Imuran will drive antibodies down once you develop them.

I do know that with MX there is a small group of people that it will drive their antibody level to zero even after they have developed antibodies. Its done it for me twice. I had stopped taking it due to surgery and then shingles. This surgery I did not stop it....so I am still at 0.

I wish your daughter good health and good luck. Please keep us updated.

Clo

I know this thread's a little old, but just thought I'd give my two cents. I've asked several specialists about this topic, and though opinions differ, the consensus seems to be that the highest risk of developing antibodies is at the beginning of treatment. So combination therapy is still extremely common, but after a year or so, many people also discontinue with the additional immunosuppressant. I was taking a similar combination, but now, only the biologic. I seem to be doing okay, although dosages may have to be adjusted in the future. However, this was preferable for me because I experienced unpleasant side-effects of immunosuppressant use.

No worries - even if the worst happens, switching biologics down the road isn't always a big undertaking.

I started out on Imuran and Mesalamine. They didn't do much and I developed an abscess that turned into a fistula. I started Remicade and got pancreatitis around the same time, which they attributed to a rare side effect of imuran. They took me off both, but since Imuran stays in your system so long (I think like 6 months?), the pancreatitis took that long to subside (spent most of it in the hospital and on a feeding tube).

But that was over 9 years ago that I started Remicade. I'm still doing great on it, even at a double dose of 10 mg/kg every 6 weeks.

I have been on this combo for almost 4 years since I started Remicade. When COVID-19 broke out last year, my GI decided I should stop taking Imuran for fear that the combo might weaken my immune system. A week ago, he prescribed it again in addition to Remicade as I’m in the middle of a flare up. He mentioned that it’s fine to re-take Imuran given I had two coronavirus infections when I was off of it.