Remicade/Methotrexate Combination Question

[onedayatatime]

My 19 year old son was diagnosed in April 2011 with Crohn's (stricture at his terminal ileum) and has been on Remicade since late July 2011. His main doctor is at UCSF. They do not put young males on the Remicade/Imuran or 6mp but they do add Methotrexate to the mix. He has been on the Methotrexate (7.5mg oral) since October. No side effects - but there is a correlation between the Methotrexate and his WBC going as low as 3.7. UCSF has decided to stop the Methotrexate and he will continue with the Remicade which has put him into remission. When I spoke with the NP today she indicated that they feel the risk of his immune system being too suppressed is not worth the benefit of the "added protection from methotrexate."

I'm not sure what I'm asking - but if anyone has had anything similar happen I would like to know. When they added the Methotrexate I was anxious and didn't want him to take it. Now they are taking it away and I'm anxious and don't want him to be without it as I'm afraid the Remicade will stop working. It seems hard to get comfortable with any treatment.

If you have any input I would love to hear it.

 

[SarahAnne]

I have no experience with Methotrexate, so I can't really answer your question properly. If the Remicade has put him in remission the doctor might feel that he can maintain remission without additional maintenance meds. Hope someone comes along with more experience. Good luck!

 

[David]

If there is a strong correlation that it is the Methotrexate that is lowering his WBC that much then I think they're making the right decision. It sounds like you have a good group of doctors who are keeping a close eye on your son which is great to hear

 

[Mountaingem]

Methotrexate just prevents the Remicade antibodies from forming in the body. He should be able to handle skipping it until his WBC goes up.

When my WBC went down too fast on Methotrexate, the GI took me off of it, waited 3 weeks and took a blood test. WBC was fine, so he very slowly worked up to a low dose-10 mg-in 2.5 increments. It tricked my system into accepting it, maybe they will try the same with your son.

I inject the Methotrexate intramuscularly, which my system tolerates much better than the pills; I don't know why.

 

[onedayatatime]

Thank you for the responses. Funny how I get comfortable with one thing and then when it changes I am in a tailspin. They have taken him off and put him back on the Methotrexate and his WBC drops everytime. The NP explained that they just don't think the benefit is worth suppressing his immune system that much. I question everything and accept nothing as the the only way. I have so much admiration for all of you suffering from any form of IBD. On a side note I have put together a team for the CCFA walk in Sacramento - I put the page up on 02/14 and as of tonight we have raised over $10,000. Trying to do what I can to help others. Thanks for your replies.