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Switching from MTX to biologicals

hi All,

I am on Methotrexate for Crohn's and seronegative arthropathy. Been taking it for 9 months and it has helped the arthropathy a lot and the Crohn's so-so. I have been dealing with side-effects of extreme fatigue as well as nausea and lack of appetite. I have recently tried reducing the dose as a test to see if things flare up and low and behold, it was terrible. My GI doc says the MTX is not putting me in remission so he wants to switch me to either Humira of Remicade. I will have a colonoscopy on Monday first and then he has to get permission from the Pharmacare plan to cover the costs of the biologics.

My question is, when you switch from MTX to biologics, do you usually quit MTX cold turkey and start the new drug or do you keep taking the MTX while the biologics start to work. I think taking both could be a double whammy of side-effects.

I appreciate your input. i really hope that the biologic works as i am so tired of being tired and would like to get back to leading a somewhat normal life.


I don't know about MTX, but with Azathioprine/imuran they keep you on it. However, I am not too happy about that as an idea, as both could act synergistically to increase risk of cancers. Drugs such as Imuran are purine analogues, and hence are included in your DNA -destablising it. While biologics frequently work on proteins that ae involved in cancer necrosis. Hence, a double hammy. [This is consitant with some findings in practice]

MTX is not a purine analogue but works on folic acid which is an important factor in cancer prevention. While MTX is used to treat certain cancers, it is known to increase the risk of any cancers by as much as 50% in rheumatoid arthritis patients. [reference below]

But, these risks have to be weighed against the risk of cancer that results from active inflammation.

Kindest regards


Ref : Arthritis Care & Research,
Volume 59, Issue 6, pages 794–799, 15 June 2008
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