Getting off Methotrexate when combined with an Anti-TNF

[lgpcarter]

Hoping someone might have some experience with methotrexate and anti-TNFs and specifically using MTX to boost the performance of the anti-TNF (in this case, Simponi) but then stopping when remission is fully achieved.

Here's the situation:

Fistualizing Crohn's in large and small bowel since 2000, with perianal fistulas. Remicade worked well for a long-time, but had two infusion reactions, so done with that. Humira didn't really work - some response to loading doses, but weekly maintenance was not enough to achieve remission.

Been doing my damnedest to avoid predinsone. Makes me hairy, crazy, hot and fat and it takes me a looooong time to get off.

Just took third loading dose or Simponi and symptoms are breaking through before next dose is due. Have previously discussed adding MTX, but haven't because I may want to have another child in the next year or so.

Have a GI appointment today and I think the choice will be MTX or maybe prednisone. If it is a short course (less than a week) I might suck it up and do it, but otherwise, I think I will go for MTX. Wondering about getting off while staying on the Simponi in order to get pregnant down the road, though?

 

[lgpcarter]

Doesn't seem like I can delete, so will respond to say "never mind". Prednisone it is for me.

 

[sickofcrohns]

I quit methotrexate while on Remicade and had no problems doing so (MTX wasn't controlling flares, anyway).

You say you had several reactions to Remicade, but was that with pre-meds? I react to Remicade on its own or with Benadryl but I don't react in any significant way when pretreated with solucortef. Anyway, premeds for biologics are something you may want to talk about with your doctor for future use.

 

[lgpcarter]

Thanks for the response.

Yes, I was premedicated with Benadryl and Solumedrol as well as Tylenol. I took a three year break from the Remicade when firmly in remission to have a child. The reactions (flushing, chest tightening) came when I tried to go back on.

I think the bottom line is that the anti-TNFs just don't really do it for me anymore.

 

[Essieluv]

I am with you on that. Anti-TNFs had no effect on me except for negative. Well, Remicade did help but I had allergic reactions to it. So no more TNF inhibitors for me, either. I hope the pred helps you without any extra nasty side effects. How long do you need to take it this time?

 

[nogutsnoglory]

A recent study was released showing the combination therapy of methotrexate and Remicade was no more effective at fighting disease than Remicade alone. Having the two drugs could be a double fist in the fight against active disease but likely won't prolong your use of the anti-TNF and may not be extra helpful at all. http://www.dailyrx.com/crohns-disea...infliximab-no-more-effective-infliximab-alone

 

[lgpcarter]

Thanks NGNG. Adding methotrexate had been previously mentioned as a possibility, but doc today (clinic setting so I see whoever is working that day - I do like and respect all three) thought it would be a "step back."

I am doing 2 weeks at 40 mg, Essieluv, and then tapering 5 mgs/weel after that. Have been on twice before and both times it took me a long time to get off. Totally 100% dreading it and further torturing myself by reading about side effects and remembering the last time I was on it.

 

[Essieluv]

Sending you hugs, I really hope it goes well and this is your best experience with pred so far.