MTX + Remicade: stopping the MTX after a year?

[pdx]

E had her regular GI appt yesterday, and everything is going well right now. Her GI suggested that we check fecal calprotectin and Remicade levels this spring, and if the numbers are good, consider taking her off MTX. (She will have been on it for a year at that point.) This was at the very end of the appt, and I wasn't expecting it, so I didn't ask any questions. I will talk to her more in depth about it at the next appt.

In the meantime, have any of your kids done this? (that is, used biologics with an immunomodulator, and then gone off the immunomodulator)

 

[crohnsinct]

No, O hasn't but she needs the mtx for her psoriasis and some joint issues anyway.

There has been plenty of discussion at the recent conferences and in papers that if mtx or Imuran was added to therapy to help keep antibodies at bay then patients can stop the immunomodulator after the first 6 months.

I guess you could make the argument that she could always go back on if she needed to.

 

[my little penguin]

Ds won't drop Mtx with his humira since he takes it for JSpA
But he has dropped asacol with the same mind set
If the doc felt he needed it again not too hard to restart it

 

[Clash]

Same here, GI mentioned dropping the mtx after 6 mos to a year but then dxed with JSpA and when the dose was increased for that it stopped the lower back pain, not to mention wrists. So we can't drop it.

 

[CrohnsKidMom]

My son is on Remicade with MTX for 7mos now, but there's been no mention from the GI about dropping the MTX. I assumed it was a rather permanent (but is anything really permanent?!) combination.

 

[Maya142]

My younger kiddo also kept her MTX or another immunomodulator but that was also for her AS. My older one stayed on MTX with her Humira because of the risk of antibodies.

I know there has been some research about only doing the combination for a certain amount of time, but curious to hear what people have been told about antibodies - does the antibodies risk go down after a year so? Just don't understand why...

 

[Farmwife]

We were told you shouldn't have one " without the other".
I believe it was because the antibody thing.
Grace was on Remicade plus Mtx and sulfasalazine but then switched to Imuran and Remicade.

I'm interested also to see what others have to say.

 

[Jenn]

We didn't do the same combo, but did drop 6mp after a year in combo with Humira. The research is mixed regarding whether to do combo - which seems to help prevent antibodies and encourage remission, but how long is combo needed after remission achieved? And weighing longterm side effect risks

 

[FrozenGirl]

My GI said combo with immunosuppressants for a year and then if in remission I would go off the immunosuppression.

 

[parentnj]

We stopped methotrexate after one year on remicade. My son has been on Remicade for 3+ years and it is still working very well.

 

[pdx]

Test results are back and they are good! Fecal calprotectin was 80. (I think it was 1800 at diagnosis.) Remicade trough level was 3.9, and no antibodies were detected. So we are going to try stopping mtx and see how it goes, knowing that we can always add it back if needed.

The Remicade level of 3.9 seems a little low to me, but if E gains 1 more pound this month, she'll jump from 300mg of Remicade to 400mg, so that will raise the level. (She's at that annoying 49 kilogram point that we were talking about on the forum last summer. 49 kg x 7 mg/kg = 343 mg, which gets rounded down to 300 mg. So she's actually been getting 6 mg/kg for a few infusions, rather than 7. And then when the dose jumps to 400 mg, she'll be getting 8 mg/kg for a while. I wish the Remicade vials came in smaller increments or that our current infusion center would split them, like our old one did.)

 

[Maya142]

Hope you're able to drop it with no issues!!

For what it's worth, my older daughter has tried to reduce MTX several times - in her case, it didn't really work and she had to up her dose again. However, it worked just as well when she went back to her original dose -- no issues at all. It was worth a try (and in fact, I'm sure she will try to get rid of it again this summer ).

So if you do have to add back MTX, it should be fairly easy. Fingers crossed she does not flare and comes off it without any problems!

 

[FrozenGirl]

Agreed, I hope the drop works out. Hopefully she can gain that 1 pound and then her Remi levels will be nice and high.

 

[Sascot]

Glad things are looking good