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Humira + Methotrexate?

I am currently on Stelara. However, my GI/rheum docs want to switch me to Humira because they think it helps better with the joints (synovitis). My GI symptoms are controlled on stelara. The GI doc wants to start me on Humira PLUS methotrexate to prevent antibody formation. However, it seems that practice is falling out of favor? Is methotrexate really necessary when starting humira????
 

my little penguin

Moderator
Staff member
Ds was on humira plus mtx for well over 5 years
He currently takes Stelara plus mtx

He started on remicade without mtx or 6-mp
This resulted in reactions to remicade within 8 months
And losing a biologic that worked

Methotrexate is very effective on peripheral joints

Good luck with humira plus mtx
 

Maya142

Moderator
Staff member
My girls were also put on MTX with Humira. They have both stayed on an immunomodulator with biologics. My older one has been on Humira and MTX for 5 years and was doing very well till a recent flare.

Many rheumatologists/GIs will use a small dose of MTX to prevent antibodies. It is also helpful with peripheral joint inflammation - joints such as the fingers, elbows, knees etc.

There aren't very many biologics and there are even fewer that work for both the joints and gut, so it's important to prevent antibody formation. If it's just for antibodies, the dose of MTX is likely to be low and shouldn't cause significant side effects.
 

Lady Organic

Moderator
Staff member
My IBD nurse told me last year that a immunosuppressor would no longer be recommended or necessary with Humira, and still is with Remicade, to prevent antibody formation. She told me that from a 2016 research. I tried to find it on the web, but didnt find it.
 

my little penguin

Moderator
Staff member
Not all immunosuppressants are equal
They no longer recommend aza/imuran/6-mp to be taken to prevent antibodies with ANY biologic including humira due the increased risk of T cell lymphoma and lymphoma in general
Methotrexate when combined with a biologic did not have an increased risk of T cell lymphoma

2015
https://www.psoriasis.org/advance/methotrexate-helps-biologics-stay-effective-for-psoriatic-arthritis


2014

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3894670/

2016
http://www.rheumatologynetwork.com/rheumatoid-arthritis/when-patients-cant-tolerate-methotrexate


Clinical trial to study just that

https://clinicaltrials.gov/ct2/show/NCT01716039

2014
http://journals.lww.com/ibdjournal/Abstract/2014/12001/P_117_Benefit_of_Oral_Methotrexate_on_Patients.155.aspx

So lots of research done on the subject
Please review and discuss pros and cons for your specific history with your doctors
 

Maya142

Moderator
Staff member
Yes that is true^- we tried to use MTX or Arava, instead of using Imuran/6MP for my girls. My younger daughter is on Imuran right now (it was unavoidable) and I find it a lot scarier than having her on MTX. Unfortunately, she reacts badly to MTX so that's not an option for her.

For kids at least, they are definitely using MTX a lot more and Imuran/6MP a LOT less.

Arava is similar to MTX - it's used most often in RA, but is also occasionally used in SpA. My younger daughter tolerates it well and it works as well as MTX for her.
 
I started Humira in September and my doctor hasn’t mentioned anything about adding Methotrexate or Imuran/6mp. I hope to get pregnant once I reach a solid remission, so that may be why other drugs weren’t suggested in addition to the Humira.
 
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