• Welcome to Crohn's Forum, a support group for people with all forms of IBD. While this community is not a substitute for doctor's advice and we cannot treat or diagnose, we find being able to communicate with others who have IBD is invaluable as we navigate our struggles and celebrate our successes. We invite you to join us.

Understanding Combination Therapy With Biologics and Immunosuppressives for the Treatment of Crohn's Disease

Thanks so much for those. It's interesting how much treatment varies by country. I wish more was known about combo therapy, because we have to make a decision soon about whether or not to continue with mtx.


Well-known member
Yeah I hear ya!

My family has a history of bad livers so mtx scares the crap out of me BUT Crohn's scares me more.

I would love to decrease or get rid of Mtx but the thought of losing Remicade makes me ill. I will keep it for as long as our doc wants us to.
Interesting. When I first started started Remicade (after being on Imuran for 4 months with limited success) my GI said the plan would be to continue Imuran for a year with Remicade then discontinue it. I assume he based that off these studies referenced. (Alas plans never work out how you plan them).
Every so often I think...hmmm if C's scopes are good will we drop the mtx. It's like a complete brain fart since we have no proof it has helped with CD but keeps his joint pain at bay...such a duh moment every single time!


Staff member
My older daughter has actually tried to drop MTX twice. She doesn't have Crohn's just AS. Both times, she flared. She couldn't even decrease the dose - when she tried to go from 15
mg to 10 mg, she flared.

I'd LOVE for her to get off it, but I figure it's helping Humira work and clearly, it helps her joints.

I do worry about her liver, especially since she is a college student who drinks occasionally.

But I definitely worry more about my younger daughter who is on Imuran - the risks with that seem even worse!
Those were very interesting. GI keeps mentioning the possibility of adding MTX (reacted to AZA so thiopurines are out)to her Humira regimen but I'm still not seeing any evidence for it. No serious joint issues , so just thinking CD. Monotherapy plus EN.
Plus can you believe that in UK they take patients off of Remicade after a year! That must be so discouraging.


Staff member
It's crazy how treatment can be so different from one GI to another. This makes it so much harder when decisions have to be made re a treatment option!

S's ped GI barely ever mentioned any treatment other than supplemental EN, the most that he ever said was that he'd consider mtx after he saw test results but, apparently, results were good enough that he never added mtx (and this was when MRIs showed inflammation! but he had no clinical symptoms). Perhaps, because we were only with ped GI for 14 months before he was transferred to adult GI, the ped hesitated starting a treatment knowing he'd soon be seeing a new GI?? (Transfer was very defined at the children's hospital, the day you turn 18 you are transferred from children's to adult.)

Adult GI wanted remi and he never mentioned combination therapy. To be honest, even knowing the risk of antibody development, I never asked if combination treatment should be considered because I was stressed enough about remi without worrying about two meds... :( Although I did ask about immunosuppressants instead of remi and his response was that he felt remi was the better treatment option so why not go with the better option (clearly a top down preference).

My aunt, in Europe, had a really, really tough time getting into remission after being diagnosed. Eventually, she was given remicade along with imuran and low dose steroids; she was one of the first patients to receive remicade in the region/country. She was kept on remi for only one year and, since then, has continued with only imuran and low dose steroids. This took her into remission and she's stayed in remission for probably close to 20 years now. To me, the fact that she needs steroids daily and periodically needs to adjust her dose for a week or two, it doesn't seem that she's ever been in deep remission?? but, throughout this time, she's certainly been well enough to live a completely normal life (with some diet adjustments).