Combination therapy

[Jenn]

Checkup yesterday and doc says latest research is that combination therapy is better. My son is doing fine on Humira alone, 3 years now (with 1 year of combo 6mp) but wants to add oral methotrexate. It will improve efficacy of and the long-term viability of Humira, reducing liklihood of antibodies. But still hard to do when he's fine at the moment! I know many of your children are on this combo, how are the side effects, if any? We will add folic acid supplement too. It's still hard to contemplate, mostly because I have to pull my head out of the sand and read about all the risks again. :/

 

[crohnsinct]

Reading your post gave me PTSD! I was there two years ago but I have to tell you everything has been A.O.K.. Is he going to be doing oral or injection? At what dose?

O is on oral and at 10mg. Doc chose oral with her because dose was so low and inflammation wasn't an issue. She only had one side effect once during the second dose. She felt like she was hit by a truck. Other than that one time all has been fine. So much so that she doses on Thursday and goes to school Friday with not so much as a hiccup.

T is on mtx as mono therapy at 20mg/week. She is doing injections because of the higher dose and active inflammation that could interfere with absorption. So far she is just experiencing fatigue the day after the shots but I am expecting that to go away the further along she gets in the treatment. If not, I think increasing her folic acid is an option.

They monitor bloods closely with Mtx and most of the scary stuff that appears goes away once you discontinue use.

Good luck! I am just glad that we have these things that allow us to continue the other drugs that are working. I would hat to give up Remicade any earlier than I have to!

 

[crohnsinct]

Just noticed in your sig that he has psoriasis also. Mtx really helped O with her psoriasis and her psoriatic arthritis. Didn't disappear but we can take her out in public without people staring now.

Maybe it will help your son also.

 

[Jenn]

Thanks Crohnsinct. I don't know the dosage yet, but it would be oral. His psoriasis was worse while on Remicade (mono). Since he built antibodies to Remicade, it seems adding mtx wouldn't hurt. Wish I had a crystal ball...

I should've added that we are going to repeat fecal calprotectin this week and check the Humira blood levels soon, because we could be missing some hidden problems. I think I'm convinced anyway, just looking for reassurance really.

Any recommendation on when to schedule the once/week mtx with the Humira injection?

 

[Maya142]

My daughter did really well on a Humira + MTX combination. She was also on weekly shots of Humira, so we did those Wednesdays and MTX on Friday. She got very nauseous and dizzy from MTX, both most kids tolerate it just fine.

Both her GI and rheumatologist now insist on combination therapy for her because we are running out of options (she has been on Remicade 3 separate times and it seems like we will be going to Simponi or Cimzia soon).

M eventually refused to take MTX with Humira and after a year of Humira without MTX, the Humira stopped working. Not sure if she had antibodies because the test wasn't available then.

Zofran really helped for nausea, as did daily folic acid.We did the shot at night so she could sleep through most of the nausea.

Good luck!!

 

[crohnsinct]

Hmmm yeah my daughter got psoriasis from the Remicade. Weird! Wea re trying to reduce Remi to a level that helps the psoriasis along with the mtx. Balancing act...too low and we anger the Crohns God's too high and she is a flaky itchy mess.

As far as dosing each med, I am not sure as my daughter is on Remicade but I do know that if Remicade and mtx fall on the same day there is no problem.

Most people dose Mtx on a Friday or Saturday night. This lets the kids sleep off the worst of the side effects and then recupe over the weekend thereby not missing school. For O it doesn't matter. So far for T, it is a good thing we dose Friday night as she s still a little tired on Sunday.

Good luck with the blood tests!

 

[Maya142]

^ Wanted to add - we were told there was no problem doing Humira and MTX on the same day, our schedule just happened to be Humira on Wednesdays. It was nice because then she didn't have to get two shots on the same day, but it shouldn't make a difference.

 

[Farmwife]

Grace was on Humira and MTX combo. No known side effects.

 

[my little penguin]

DS is on humira and Mtx
No issues