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Crohn's Disease Forum » Treatment » Remicade/Infliximab » Remicade and Methotrexate together?


 
03-03-2013, 09:59 AM   #1
AK47
 
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Remicade and Methotrexate together?

Hello everyone,

I hope somebody can help me on this one..been looking for information for hours but havent had much luck on any personal experiences.

I'm currently on Remicade on my 4th infusion, this 4th infusion has gone really well and it seems like its working wonderfully.

After my recent appointment my GI wants to to try other drugs such as Methotrexate whilst on Remicade. Now, I understand most people on Remicade take Aza or 6MP but I had a pretty bad reaction to both and couldnt tolerate the drug. (So im only taking Remi every 6 weeks)

I've been advised that I need to be on other immunosuppressant drug in order to reduce the risk of developing antibodies to remicade, so we are considering Methotrexate.

Has anyone been in a similar situation? Anyone taking both Remi and MTX?

Thank you!!
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Crohns Disease
Diagnosed May 2012

Current Meds
Humira 40mg Every 2 Weeks

Previous Meds
Pred (highest 40mg) - Works wonderfully when im flaring! Makes me feel 'normal' and get so much energy.
Infliximab (Remicade) 5 Infusions, switched to Humira

Failed Meds
6MP - (Severe rash over body/chest pains/extreme fatigue)
Imuran (Aza) - Same as 6MP
Asacol - Made symptoms worse

Diagnosed with Primary sclerosing cholangitis (PSC) in Aug 2012
03-03-2013, 10:51 AM   #2
Clash
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My son takes both Remi(highest dose every five weeks) and MTX(25mg every Sunday). He has been on the Remicade since last May and the MTX since October.

The meds haven't bothered him as far as any flu-like symptoms or other side effects some have mentioned with Remi or MTX.
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Dx May 2014: JSpA
8/2014 ileocecectomy
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03-03-2013, 11:00 AM   #3
sfmreb2
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I was on remicade and MTX and really liked it. I was on the pills, 12.5 mg a week. I was taken off it and Remy has not worked as good since.
03-03-2013, 11:11 AM   #4
AK47
 
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Clash - Are those the only meds your son is currently taking? Did he try Imuran or 6MP instead of MTX?
Does he feel any additional bad side effects from adding MTX on top of Remi? Im worried I'll be knocked out every weekend after taking MTX..as weekends are the only 2 days I have to socialise

sfmreb2 - Sorry to hear it hasnt worked good since coming off MTX. What was the reason you came off MTX? How long were you on this combination for?

Thanks for all your responses btw!
03-03-2013, 11:37 AM   #5
Clash
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I know I've read many posts about members experiencing fatigue or flu-like symptoms after taking their MTX. It seems from the post most experience on the pills and some switch to the MTX shot and don't get as many side effects.

C hasn't experienced any of this though. He gets a little tired after his Remicade infusion but it is probs the benedryl and not the Remicade and doesn't prevent him from doing anything. He hasn't felt any side effect from taking MTX(touch wood)

He went straight to Remicade at dx. So he has been on no other meds(except pred while waiting for Remi approval). He does take folic acid every day. It was px'ed with MTX as MTX is an antifolate. Our wiki says the common side effects can be reduced with folic acid supplementation so maybe that is why but I don't know.
03-03-2013, 12:15 PM   #6
sickofcrohns
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I was on both for about a year and a half. The MTX (25 mg weekly, intramuscular shot in leg) did nothing for me but cause irritating side effects. It was a relief to get off it.

I've been on Remicade for 9 years now, steroid-free for almost 6 months. (Yes, it took me 10.5 years to get off prednisone!) I've never heard of a doctor saying that someone has to be on another immune suppressant at the same time as Remicade other than as a means to control flares.
03-03-2013, 12:32 PM   #7
Clash
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Sickofcrohns, the immunosuppressants, 6MP, AZA or MTX are sometimes px'ed to prevent your body from building antibodies to the Remicade. Although, for young males this combo presents a higher risk for HSCTL.

Someone also recently posted GIs are backing away from px'ing the combo and may only px combo at induction then stop the immunosuppressant after 6 mos.
03-03-2013, 02:04 PM   #8
heisenberg
 
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I am on Remicade and methotrexate 15mg. Same reason as you. So far I haven't noticed any problems with either but I only started both 2 weeks ago. I was told to take my mtx on a Monday so even if it did make you queezy you would be ok by the weekend. I think this is what you will be told to do as well as this seems standard for uk people. You will also be told to take 5mg folic acid on the Friday. I would say definitely go for the combo as it is double the effectiveness of Remicade alone at keeping people in remission for over a year.
03-03-2013, 04:24 PM   #9
mbishop
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You may want to look into changing biologicals. The latest Cochrane review on it concluded:

"The addition of methotrexate to infliximab therapy does not appear to provide any additional benefit over infiximab monotherapy. "

http://onlinelibrary.wiley.com/doi/1....pub3/abstract

Depending on where your active disease is, Budesonide may be a co-option with the Remicade also.

Best of luck.
03-04-2013, 12:51 AM   #10
sfmreb2
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Clash - Are those the only meds your son is currently taking? Did he try Imuran or 6MP instead of MTX?
Does he feel any additional bad side effects from adding MTX on top of Remi? Im worried I'll be knocked out every weekend after taking MTX..as weekends are the only 2 days I have to socialise

sfmreb2 - Sorry to hear it hasnt worked good since coming off MTX. What was the reason you came off MTX? How long were you on this combination for?

Thanks for all your responses btw!
I was getting treated at the VA and a contract GI guy thought I should get off of it. So I did . I was on it for about 9 yrs. I took the pills and never noticed any side effects. I think I started on 15 mg, My original GI said I did not have to have a liver biopsy until 1 gram. The reason I started the MTX was imurin made me sicker than a dog and put me in the hospital for a week. I lost over 10 lbs in one night. I had no idea that much could come out of one end. I was so weak I could not get out of the hospital bed, that became ai humbling experience. First time in over 50 years I had to wear a diaper. Sorry that is probably more than you wanted to know. For some reason I get hyper just thinking about it. And that is why I started MTX.
03-04-2013, 01:06 AM   #11
DisNikki25
 
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I am taking Imuran as my immune suppressant... which compliments my Remicadee infusions... I am currently on 225 MG per day (as it is based on weight) for the Imuran... I have just started this as I did do just the test dose of 50 mg for a month... I seemed to tolerate it for the test... so we'll see how I do with the target dose... The lady I do my Remicadee infusions with is taking Methotrexate... She is taking the Remicadee for Rheumatoid arthritis... She seems to be tolerating it well now... as she did take it before but that was when she was taking Humira... but wasn't able to tolerate it so well... Hope this helps a little...
03-04-2013, 04:14 PM   #12
AK47
 
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You may want to look into changing biologicals. The latest Cochrane review on it concluded:

"The addition of methotrexate to infliximab therapy does not appear to provide any additional benefit over infiximab monotherapy. "

http://onlinelibrary.wiley.com/doi/1....pub3/abstract

Depending on where your active disease is, Budesonide may be a co-option with the Remicade also.

Best of luck.
I've been advised by my GI that she might consider switching me over to Humira, what i dont understand is if remicade is working good, why switch me over? What if Humira doesn't actually work and I go back to Remi and that stops working!
03-04-2013, 04:25 PM   #13
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I am just concerened because I'm glad that Remicade has started working for me and its the only thing that has kept me healthy and strong without any side effects. Im just slightly worried it might end up making things worse for me and I might end up completely loosing the effect of Remi.

I was on steroids for a while but had to come off them because I was on them for over 8months and I was getting really bad side effects, still suffering from the side effects (pretty bad acne on my back and forehead)

I think i'll be happy to give it a try and discuss it further with my GI
03-04-2013, 04:27 PM   #14
AK47
 
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Sickofcrohns, the immunosuppressants, 6MP, AZA or MTX are sometimes px'ed to prevent your body from building antibodies to the Remicade. Although, for young males this combo presents a higher risk for HSCTL.

Someone also recently posted GIs are backing away from px'ing the combo and may only px combo at induction then stop the immunosuppressant after 6 mos.
Sorry if this a stupid question, what is HSCTL?
03-04-2013, 08:05 PM   #15
Clash
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HSCTL is hepatosplenic T-cell lymphoma, it is a rare, dangerous cancer and from the results of several studies the FDA required black box warning to be placed on the biologics:

"Unusual cancers have been reported in children and teenage patients taking TNF-blocker medicines. Hepatosplenic T-cell lymphoma, a rare form of fatal lymphoma, has occurred mostly in teenage or young adult males with Crohn’s disease or ulcerative colitis who were taking REMICADE® and azathioprine or 6-mercaptopurine. For children and adults taking TNF blockers, including REMICADE®, the chances of getting lymphoma or other cancers may increase."

The increased risk of HSCTL was not realized in clinical trials because the sample size was too small. Now I think there have been 38 reported cases(I could be wrong on the number) the latest study added MTX(methotrexate) to the list of immunosuppressants and biologic combos.

Have you had the Remicade HACA antibodies test? This test will show if you have built up antibodies to Remicade. If you have then a switch to Humira is probably the best option. If you haven't then your GI is px'ing the immunosuppressant(MTX or 6MP or AZA) to prevent your body from creating antibodies to the Remicade.
03-05-2013, 03:58 PM   #16
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Ah yes, I've researched a lot about Lymphoma and the risk of getting this cancer whilst on Remicade.

I guess theres always risks with medications, just have to hope for the best.

Thank you very much for clarifying that for me and for providing a detailed explanation. I had no idea about a HACA test, after a quick Google search..I think its one of the questions I will now raise with my GI at my next appointment. Need to establish If I have developed antibodies and hopefully start MTX.
03-26-2013, 06:07 PM   #17
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My 17 yr old son is on Remicade and MTX, today will be the 6th week on MTX which hasn;t seemed to do anything, while 2 infusions of Remicade 2 weeks apart seemed to have helped a lot. The Remicade seems to really help for a few days and then things start sliding back. I get really hopeful that things are finally going better but then today he is not feeling well at all. Still planning on him going back to school after spring break as he has now missed 9 weeks of school. Sigh!
Anyway our GI is keeping him on MTX to keep the Remicade working longer and he also said the MTX helps lower the chances of cancer. This is opposite of what you are saying Clash! I asked my brother about this as he worked in the development of drugs for years and the generic of Remicade and he said he didn't know anything about that. He no longer has access to a medical library so he couldn't say. Now it looks like for teenage males that is a higher chance?
07-05-2013, 02:21 PM   #18
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Hi i know this is an old thread but I am on remicade 300mg every 8 weeks and my consultant is adding methotrexate to it. I dont really know much about this drug so any advice would be appreciated thank you.

Alison
07-05-2013, 02:42 PM   #19
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Hi Alison, our GI prescribed the metho because of evidence that it helps the remicade to work longer. It hasn't seemed to do a thing for the crohn's symptoms when my son took it by itself and sometimes it makes him feel really fatigued the day after his weekly dose. And then some weeks he feels fine the next day. I have to trust my wonderful GI, but I do really wonder about my son having a day most weeks that he feels bad, which is why he takes it on Saturday only and has all day Sunday to rest up. There is also evidence that it lowers the risk of some cancers that the remicade ups the odds with. Good luck to you.
07-05-2013, 02:50 PM   #20
Clash
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emillerstudio, do you have a source for the evidence that it lowers the risk of some cancers? I have not heard this, in fact the studies members have posted show the opposite.

I'm not sure how it would lower the risk of cancers as it is an immune suppressant so it suppresses the immune systems abilities not enhances them. I do know that it can help prevent you from developing antibodies to Remicade.

Thanks!
07-05-2013, 02:58 PM   #21
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Hi she didn't really go into it. The nurse will ring on Monday to discuss it. I guess I am having it to prevent me having antibodies to the Remicade then.

Alison
07-05-2013, 03:10 PM   #22
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Hi,

I have a cousin who is on both, and he takes the methotrexate to prevent antibodies!
07-05-2013, 10:32 PM   #23
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Hello Clash,
Only from my excellent GI doctor who said it would lower the cancer risks, but I don't have his source for that, sorry. So I guess don't quote me on that one, I will ask him about it again next time my son sees him.
08-06-2013, 11:59 PM   #24
BoyMama2000
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From what I have learned, methotrexate helps to prevent you from making antibodies to remicade. I am not sure it lowers cancer risk but studies have not shown the same issue with aggressive cancer when using MTX and biologics as they see with 6mp and the other more traditional Crohns immunosuppressant meds. It may be safer to combine especially with adolescent, teenage and young men.
08-17-2013, 03:52 PM   #25
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Below is what my brother who has worked on developing a generic version of Remicade sent me to explain the rationale for taking methotrexate:
Humira is a fully human antibody against Tumor Necrosis Factor, so it is neutralizing the same molecule as Remicade. Remicade is a mouse-human chimeric antibody, so it will be more prone to generating antibodies against itself, due to the mouse sequences in the Remicade, which are more likely to be recognized by the body as foreign protein than the fully human sequences in Humira.
The methotrexate is used as an anticancer therapy in leukemia and many other cancers, so I suppose the rationale is to use it prophylactically to minimize the chances of the anti-TNF therapy allowing a malignancy to gain a foothold. I did come across a few studies reporting using methotrexate prophylactically to prevent lymphomas that were in remission from spreading into the central nervous system https://www.ncbi.nlm.nih.gov/pubmed/20564149 .
08-17-2013, 11:13 PM   #26
Jennifer
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Hi emillerstudio. I really would be interested to hear where your GI got the information that Methotrexate can help prevent certain cancers that Remicade can cause. This is the first time I've heard about it and a quick search doesn't produce any results. Before continuing to state that Methotrexate does do as your GI mentioned where cancer is concerned I'd appreciate it if we could all see an actual source.

While Methotrexate was originally used to treat cancer and can help prevent it from progressing for those who have already been diagnosed with cancer the dose has been reduced so it can be used for other health conditions like Crohn's disease.

"Methotrexate is part of a general group of chemotherapy drugs known as anti-metabolites. It prevents cells from using folate to make DNA and RNA. Because cancer cells need these substances to make new cells, methotrexate helps to stop the growth of cancer cells." http://www.cancer.org/treatment/trea...s/methotrexate

I'd have to do more research on the doses but my guess is that someone is thinking that since it can be used to prevent further progression of cancer cells for patients being treated for cancer then that must mean it prevents cancer. If that were the case then everyone would take Methotrexate. I believe dosage plays a huge factor in this case but like I said, I'd have to look it up. Chances are that the dose used to treat and prevent more cancer cells from forming for patients who are already being treated for cancer is much higher than the dose used to treat Crohn's disease.

"Methotrexate is given for a number of diseases including, but not limited to Crohn’s disease, arthritis and psoriasis. It is also given for the treatment of some cancers but in much higher doses than you will be receiving." http://www.med.unc.edu/gi/specialtie...thotrexate.pdf
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Currently in: REMISSION Thought it was a flare but it's just scar tissue from my resection. Dealing with a stricture. Remission from my resection, 17 years and counting.
08-17-2013, 11:52 PM   #27
DustyKat
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I think when the use of immunosuppressives and biologics strays from their original intention the waters can become muddied.

This seems to be so when you are dealing with a disease thats source is autoimmune and perhaps even more so when that disease is IBD.

I too have never heard that Methotrexate can reduce the risk of cancer when used in combination therapy. As has been stated previously the literature we have been privy to suggests the opposite is true and whilst the immunosuppressives Azathioprine (Imuran) and 6MP appeared to be the original culprits at least one recent European study shows that Methotrexate also adds to the risk of developing Hepatosplenic T-cell Lymphoma:

http://mobile.journals.lww.com/euroj...&article=00009

Dusty.
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10-11-2014, 02:39 PM   #28
Jay Woodman
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@AK47 My GI. Has also recommended Remicade + Methotrexate so I'm currently searching the Forum to try to understand this drug combination.
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10-11-2014, 02:51 PM   #29
Jay Woodman
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I was on both for about a year and a half. The MTX (25 mg weekly, intramuscular shot in leg) did nothing for me but cause irritating side effects. It was a relief to get off it.

I've been on Remicade for 9 years now, steroid-free for almost 6 months. (Yes, it took me 10.5 years to get off prednisone!) I've never heard of a doctor saying that someone has to be on another immune suppressant at the same time as Remicade other than as a means to control flares.
I appreciate hearing about Remicade from a long time user.
10-11-2014, 02:53 PM   #30
Jay Woodman
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Sickofcrohns, the immunosuppressants, 6MP, AZA or MTX are sometimes px'ed to prevent your body from building antibodies to the Remicade. Although, for young males this combo presents a higher risk for HSCTL.

Someone also recently posted GIs are backing away from px'ing the combo and may only px combo at induction then stop the immunosuppressant after 6 mos.
Clash, I never thought of asking if my GI if we could do the combo for induction only...
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