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REMICADE and METHOTREXATE

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Posted 7/28/2011 3:53 PM (GMT 0)
My son is having is 3rd REMICADE infusion today.  I was curious to find out if everyone esle on here that is getting REMICADE infusions are also having to take Methotrexate.  They want me to start my son on this and I am leary to put yet another drug into his body on a regular basis.      Does anyone have any feedback for me on the Methotrexate?  It is supposed to stop his body from producing antibodies against the REMICADE.  But the REMI is already suppressing his immune system.  Wouldnt this just suppress it even more? cry

Thanks!

 

Posted 7/28/2011 4:07 PM (GMT 0)
I can only tell you that my mom is on a combo of Remicade and Methotrexate to treat her RA. She has had no ill effects from either one. She has been on them for about 5 years now. Granted she is 78 years old and really has no choice but to take these drugs. It's either that or she's crippled. Her immune system is fine (she never gets sick ie: colds and such), in fact she just beat breast cancer and had to go thru chemo and everything and she is doing really well.

Best wishes to you and your son.
Posted 7/28/2011 4:09 PM (GMT 0)
BBUC,  thanks for the feedback. glad your mom is doing well! :-)
Posted 7/28/2011 5:25 PM (GMT 0)
I don't know about Methotrexate dosages but the dosage my doctor wants me to take of Imuran is lower than the amount normally used for UC so I doubt it lowers my immune system much. However, I believe that all of the cases in young male patients who have gotten cancer from Remicade were on a combo of Remicade and Imuran/6MP or Remicade and Methotrexate. So, if I were you I would do some more research before letting him take the combo of those two. Especially if the Remicade works alone and the Methotrexate is just to potentially keep him from developing antibodies.
Posted 7/28/2011 7:05 PM (GMT 0)
I am on humira and methotrexate, and honestly, i don't get sick anymore. I can't remember the last time i had a cold
Posted 7/28/2011 7:25 PM (GMT 0)
My daughter has been on Remicade for 1 year and has also been on Imuran with it. I was very nervous when she 1st went on Remicade, to the point that I asked her to wear a mask while flying due to all the germs being recirculated. She has flown many times in the past year with no mask and does not seem to pick up anything more often than before. Unfortunately she has not been responding as well (flaring), so they ran a Remicade level and it was fine and they also tested for antibodies and there were none. Our GI always pairs the two drugs to reduce the risk of developing antibodies to the Remicade.
Posted 7/28/2011 9:25 PM (GMT 0)
It is generally recommended that patients receiving anti-TNF therapy also go on MTX or Imuran. The MTX/Imuran provide two benefits - patients are more likely to achieve remission and stay in remission with combo therapy than with anti-TNF alone; additionally, patients are less likely to develop anti-bodies to the anti-TNF agent if they are on MTX/Imuran. The dose is generally small (you'll notice it's probably called "low-dose methotrexate" if you have looked it up), so the side effects are rarer. My GI has also told me that they generally see fewer side effects in Crohn's patients than in RA or other patients taking the medication (this is anecdotal from a hepatologist, I have not seen any papers to verify this).

A paper that I have appreciated on the current approaches to Crohn's treatment is the 2009 Consensus Report from the Canadian Association of Gastroenterology (www.cag-acg.org/uploads/cag_cpg_crohnsmar2009.pdf). A consensus report is where the specialists get together and vote on certain common approaches to treatment to determine what should be done in the majority of cases.

If you're interested enough to take a look at the Consensus Report you'll see that Statement 12 concerns whether patients derive benefit from taking anti-TNF and immunosuppressive (e.g. MTX) therapy at the same time. The votes were 72% agree strongly and 28% agree with minor reservation. The grade was low - essentially meaning there's not enough research available to make a confident decision.

Statement 11 concerns whether you can reduce antidrug antibody formulation by i) Regular therapy, ii) Concomitant immunosuppressive therapy (MTX), iii) Pretreatment with corticosteroids. The votes were 52% agree strongly, 44% agree with minor reservation, 4% agree with major reservation. The grade on this was high - meaning that they are very confident in the decision and it's unlikely to change.

Probably too much information, but I was very interested in this as well (I was recently put on MTX in addition to my Humira) so I have done a lot of research on it.
Posted 7/28/2011 10:57 PM (GMT 0)
Oh shoot, didn't realize I was in the UC forum. The paper is more for Crohn's, but they have similar consensus papers for UC as well. What a waste of a long post. :(
Posted 7/29/2011 1:09 PM (GMT 0)
My doctor wants me to go on the methotrexate with my remicade and I won't do it.  I'm scared enough going on the remicade I will not go on both.  Exspecially because I am fine with just the remicade.  I know my doctor said it is a low dose that doesn't have many side effects because it is so low.  I still am not comfortable with it.  That is just my opinion.  I know most people that developed the cancer were on both at the same time.  I got alot of colds this last year and I just don't want my immune system lowered.  Maybe if I wasn't doing well with the remicade I would do both but then I might just op for surgery once the remicade stops working. 
Posted 7/29/2011 1:50 PM (GMT 0)
The position that the GI clinic at Sick Kids in Toronto takes is that they will not give Imuran and Remicade at the same time. When methotrexate was mentioned our GI just shock her head and said she would not do that. I did not push for more information because we had personally arrived at the point that we did not want any more drugs.
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