Adding additional immunosupressant to biologics

[BoyMama2000]

Have your doctors told you that biologics work better when used with methotrexate, 6pm etc. or is the primary reason to suggest this to avoid developing antibodies?

My son's doctor wants him to add methotrexate to Stelara hoping it will reduce inflammation in his rectum. The rest of his scope looked good after increasing Stelara to every 4 weeks about a year ago.

We were wondering if we should ask to move to another biologic like Humira or Remicade instead of adding in another med. Doctor seems hesitant.

Thanks

 

[awoenker12]

Yes, one of the main reasons doctors prescribe a biologic and an immunosuppressant together is to prevent antibodies forming to the biologic. It may not be a bad idea to add an immunosuppressant. Has your son tried any other biologics and if so has he formed antibodies to it?

For me personally, I am on Remicade and 6mp which has been working great for me.

 

[Scipio]

Adding an immunosuppressant does reduce the risk of formation of antibodies directed at the biologic. But in the case of Stelara the risk of antibodies appears to be quite a bit lower than it is with older biologics such as Remicade or Humira. Thus many docs are forgoing the immunosuppressants with Stelara. The fact that your doc wants to add one in spite of Stelara's low immunogenicity suggests that he really is trying to get a boost to stamp out that residual rectal inflammation.

Also, I'd be reluctant to move to another biologic as long as Stelara is still controlling most of the disease. Your first biologic is generally your best shot. It's a good idea to stick with it for as long as you can.

 

[BoyMama2000]

Thanks for your feedback. I was wondering if adding something else really boosts the medication. I know it is best to stay on this one. He has been on it for 2 years and this is his first biologic. Knowing it is less likely to have antibodies against it is interesting. I did not know that.

I really don't think my son will agree to adding anything else. He is willing to continue using suppositories in adWedition to Stelara which I hope will do the trick for the rectum.

We are having hassles with our insurance company for the hydrocortisone supp so are paying out of pocket for it for 2 months. They will cover canasa but only for one time a day. Hoping the doctor's can get it approved for twice daily.

Thanks for the input!

 

[Poppysocks]

Yes, one of the main reasons doctors prescribe a biologic and an immunosuppressant together is to prevent antibodies forming to the biologic. It may not be a bad idea to add an immunosuppressant. Has your son tried any other biologics and if so has he formed antibodies to it?

For me personally, I am on Remicade and 6mp which has been working great for me.

Kind of random question, but do you know why do they tell you to not have sex while on 6 mp/imuran?

 

[awoenker12]

Kind of random question, but do you know why do they tell you to not have sex while on 6 mp/imuran?

Never heard that you can't. The thing that you have to understand is that 6mp and Imuran suppress your immune system, making it easier to get infections. That could possibly be why.