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Crohn's Disease Forum » Parents of Kids with IBD » Newbie looking for insight re: Humira & Methotrexate


01-28-2015, 02:16 PM   #1
Lauren77
 
Join Date: Jan 2015
Location: Rockland County, New York
Newbie looking for insight re: Humira & Methotrexate

Hi everyone,

My name is Lauren and I am a single mom to Meaghan, a 12 year old girl who has CD. Brief Hx:

Dx in 9/13 and was put on Lialda & Entocort for 6 months. 2 bouts of c. Diff and then a full blown flare. Switched to different Ped. GI.

Hospitalized at the end of March 2014 and put on Remicade, immediately went into remission, which has continued to present day.

12/27/14 - Anaphylactic reaction to Remicade, testing over past month revealed the presence of anti-bodies.

Her team is now recommending concomitant Humira & Methotrexate therapy but I'm having 2 issues with this:

1. She has not been in a flare for almost 1 year. She had 1 weekend of multiple BM's (semi-solid to solid, no blood) but that was related to Omnicef use for a sinus infection and once that was finished, she resumed to normal, 1-2x per day BM's.
2. The preponderance of clinical research doesn't prove to me that Methotrexate reduces immunogenicity to Humira. There is more evidence supporting concomitant therapy with Remicade because it is chimeric in nature.

She also hasn't been scoped since 9/13 which to me, would give us more insights into her current disease state. This seems very harsh for maintenance therapy and I left a message to discuss this further with her team. In the interim, we're waiting for the results from her baseline blood work and insurance approval for Humira is still pending. This buys me a little more time to make an informed decision and to ask the good folks of this forum for their opinions, experiences, and recommendations. Any direction to clinical research would also be appreciated.

Thank you in advance for your help!
01-28-2015, 02:21 PM   #2
crohnsinct
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Hi there and welcome!

I also have not read very convincing studies that the addition of methotrexate does much to prevent antibodies. I imagine given the allergic reaction to Remicade they are thinking better to get in front of it with the Humira.
However, there are plenty of people who have had a reaction to one biologic and gone on to have a successful run with a subsequent biologic. I will see if I can get my hands on some of those studies but in the meanwhile paging MLP, Maya (I think one of her daughters switched biologics..or maybe just restarted) and Clash.
__________________
Daughter O dx 2/1/12 at age 12
Crohns & Remicade induced Psoriasis
Remicade
Vit d 2000IU
Multi vitamin plus iron
Calcium

Previously used - Prednisone, Prevacid, Enteral Nutrition, Methotrexate oral and injections, Folic Acid, Probiotics, Cortofoam

Daughter T dx 1/2/15 at age 11
Vitaligo, Precoscious puberty & Crohn's
Remicade
Vit D 2000IU

Previously used, Exclusive Enteral Nutrition, Methotrexate (injections and oral), Folic Acid, Entocort,IBD-AID Diet
01-28-2015, 02:29 PM   #3
Lauren77
 
Join Date: Jan 2015
Location: Rockland County, New York
Thank you so much for your quick response! I am in complete agreement with you and can certainly appreciate that they're trying to be proactive in light of her recent Remicade reaction but I've also heard that some patients successfully switch to other biologics with no antibody formation.

Any additional studies you can point me to would be great. Thanks again!
01-28-2015, 02:46 PM   #4
Clash
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My son recently had reaction to remicade and subsequent testing showed high level of antibodies. We are switching to Humira as well.

My son was already on combo therapy with MTX while on remicade. I think he built antibodies due to having to stop remi shortly before surgery then starting back. At the time we had decided to move on from remicade then after surgery my son wanted to give remicade another go.

He would be on mtx regardless because he also has JSpA related to IBD and it has been good for that dx.

I do know some GIs are pxing mtx for the first 6 months of a new biologic then coming off the mtx. I'll see if I can round that paper up.
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Clash
Mom to
C age 19
dx March 2012 CD

CURRENT MEDS: MTX injections, Stelara


Dx May 2014: JSpA
8/2014 ileocecectomy
9/2017 G tube

PAST MEDS: remicade, oral mtx, humira
01-28-2015, 02:53 PM   #5
Lauren77
 
Join Date: Jan 2015
Location: Rockland County, New York
Thanks for sharing your son's experiences with me and I hope he is doing well. How long was he on the Remicade & MTX?

I would definitely be interested in seeing that paper if you can find it. Thanks again.
01-28-2015, 03:03 PM   #6
Clash
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He was 2 years on remicade. 3-6 months into remicade we started mtx.

I'll keep looking for the paper.
01-28-2015, 03:33 PM   #7
Maya142
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My daughter has been on both Remicade and Humira. She was on Humira just by itself first but even when it was given weekly, it wasn't controlling her symptoms. We added MTX to sort of "boost" Humira. It worked great until M had side effects and refused to take MTX. A few months later Humira eventually stopped working (antibody test was not available then, so not sure if it was antibodies), and M was put on Remicade. By itself, Remicade didn't do much, but once we added MTX (yes, again), it was like magic!

It might just be my daughter, but she definitely responded better to a combination of an immunomodulator (now Imuran and Remicade) and an anti-TNF. Studies do show that antibodies are common with Humira and given how few options there are for kids, it may be that your GI just wants to play it safe and reduce the chance of her developing antibodies.

My daughter had trouble tolerating MTX but most kids have no or mild side effects.

I would push for scopes because there are quite a few parents who have asymptomatic kids on the forum. If the scopes show that she really doesn't have a lot of inflammation, then perhaps you can convince them to try just the Humira.

Good luck!
__________________
Mom of M (20)
diagnosed with Crohn's Disease at 16
Juvenile Idiopathic Arthritis at 12
Juvenile Ankylosing Spondylitis at 16

Mom of S (23)
dx with JIA at 14
Ankylosing Spondylitis at 18
01-28-2015, 03:36 PM   #8
Maya142
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Here is one study about antibodies and Humira and MTX:

http://www.internalmedicinenews.com/...e8d135725.html

A high methotrexate dosage (at least 22.5 mg/week) sliced the rate of antibody production against adalimumab by a statistically significant 86% compared with patients who got no methotrexate, and by a significant 61% compared with patients on low-dose methotrexate (10 mg/week or less), Dr. Charlotte Krieckaert reported at the annual European Congress of Rheumatology.
01-30-2015, 11:52 AM   #9
Lauren77
 
Join Date: Jan 2015
Location: Rockland County, New York
Sorry I'm responding so late Maya! Thank you so much for sharing your daughter's experiences and for providing me with that study.

My daughter tends to have adverse reactions to everything under the sun...so much so, that both her pediatrician and pediatric GI want her to see a pediatric immunologist to do extensive testing. Given her track record, I'm fearful that she won't be able to tolerate MTX much like your daughter.

I am definitely going to push her Dr. to do a scope before we change her Tx plan.

Thanks again Maya!
01-30-2015, 12:10 PM   #10
my little penguin
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Ds like your dd reacts to everything and anything .
He was placed on remicAde and after 7 infusions had his first reaction.
8 th infusion we added Iv steriods -another reaction.
Antibody tests showed no antibodies but he still reacted .
He was then started on humira in April 2013
In June of 2014 he developed JSpA in his hands .
By August he was placed on mtx to treat the arthritis.

He has reacted in the past to food insects drugs pollens etc...
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DS - -Crohn's -Stelara -mtx-IVIG
01-30-2015, 12:36 PM   #11
Lauren77
 
Join Date: Jan 2015
Location: Rockland County, New York
"Glad" to know that my daughter is not alone with her hyper reactivity. Prior to each Remicade infusion, she was pretreated with Benadryl and Solu-Medrol to mitigate a potential reaction but ultimately, she had full blown anaphylaxis not even 1 minute into her 4th. She had 2 different tests and it was the second one - the AnserIFX (Prometheus Laboratories) that yielded the correct result, which was that she had definitely developed antibodies to IFX.

I'm very curious to see what the allergy testing reveals. Thank you for sharing your son's story and I hope he's doing well on his current Tx plan.
01-30-2015, 12:38 PM   #12
Grumpy1
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I'm not young but I do react to most drugs - had a bad reaction to my 5th or 6th infusion of Remicade can't remember which. Was put on Humira which I also reacted (not as badly) to added mtx and have been on both since October with good results and minimal side effects, added bonus to mtx is that it deals with the arthritis that came with my crohns
01-30-2015, 12:56 PM   #13
my little penguin
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Please be very aware of false positives on allergy testing
Make sure to go to a board certified pediatric allergist .
If your kiddo is hypersensivity the odds of false results are very high
IgG testing is not recommended
Neither is random IgE testing ( called fishing )

Here is link
http://www.choosingwisely.org/doctor...ma-immunology/

Not the one I was looking for but...
Let me know if you have questions
01-30-2015, 01:52 PM   #14
Lauren77
 
Join Date: Jan 2015
Location: Rockland County, New York
Thanks for the info. and I will certainly do some more research on this topic! Dr. is Board Cert. in Ped. Allergy/Immunology and is affiliated with NY Presbyterian Weill Cornell in NYC (my daughter's Ped. GI is there as well). This allergist was also recommended by my daughter's pediatrician and I made an appointment for 2/16.

I'll keep you posted
01-30-2015, 03:48 PM   #15
Jenn
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Starting Humira right away will keep her in remission after stopping Remicade. A scope now should look good and won't tell you much. Going unmedicated, the disease will resurface eventually, and usually silently. You could talk to the doctor about postponing MTX for awhile, to see how it goes first. My son is on Humira only, though we did need a years' 6mp combo to boost him til his weight was high enough to switch from pediatric to adult dose. Combo therapy is very effective. Best of luck.
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Jennifer ~ son dx at age 8, Sep 2010
currently on Humira, Feb 2012+, MTX (20mg) Aug 2017+, folic acid
past use: 6mp for Sep 2010-Apr 2011 (not effective enough), then Remicade April 2011-Dec 2011 (built antibodies); additional 6MP Aug 2012-Sep 2013; Periactin for appetite Sep 2010-Sep 2013
other: Centrum chewable multi; calcium-vitD;
Derma-Smoothe for psoriasis rashes; Alrex, Zaditor eye drops for vernal conjunctivitis; history of asthma, ear infections
01-30-2015, 07:12 PM   #16
Maya142
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My daughter didn't have an allergic reaction to MTX - she just got very nauseous and dizzy with it and it made her miserable enough that she would eventually start refusing to take it, even though she knew how much it helped.

Most kids do just fine on MTX - Clash, my little penguin's and crohnsinct's kids all come to mind.

My daughter is, however, able to tolerate a different immunomodulator which also prevents antibodies - Imuran. She had some mild nausea during the first few days but really no side effects after that!

Good luck!
01-31-2015, 12:17 PM   #17
Lady Organic
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In adults, MTX can be taken alone as maintenance treatment.
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''UC-like Crohn's'' since 2001:
on: 25mg 6-MP (purinethol)+ B12 shots
minor hands/wrists chronic arthritis since 01/2013

Diet: ''IBD-AID'' : http://www.nutritionj.com/content/13/1/5+ organic food only
suppl Curcuminoid extract, Inulin,psyllium, apple pectin, Vitamin D

past meds:
pred 50mg, 5-ASA, cortifoam, Imuran (failed) Purinethol (success) methotrexate (failed CD and arthritis).
01-31-2015, 12:24 PM   #18
Farmwife
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My 6 yr old girl does MTX injections and has no side effects from it.
She takes in in combo with Remicade and sulfasalazine.
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I'm mom to............... Little Farm Girl 8 yr old
Ibd (microscopic)
(12/28/12),
dx Juvenile Arthritis
(12/13/13)
dx Erthema Nodosum
(8/13/14)
Bladder and Bowel Dysfunction
(10/14/13)
Ehlers-Danlos Syndrome dx (1/26/17)
Remicade started on (9/8/14)Every 4 wks
Azathroprine started on 10/9/15
EN/EEN- since (1/12/13)
Past Meds- LDN, Humira, Pred, MTX, Sulfasalazine
01-31-2015, 03:39 PM   #19
CrohnsKidMom
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I can't offer any insight on the combo of MTX and biologics, but my 10 yr old son has been on MTX as a monotherapy for about 18 mos now, and it is working well. He has some mild nausea which diminishes the morning after the needle, and had also experienced some fatigue and looser stools when he first started the med. Those have resolved now. I hope you come up with a good treatment plan that works well for your child.
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Son diagnosed with Crohn's March 2013, at age 8
01-31-2015, 06:35 PM   #20
crohnsinct
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O has been on combined therapy (Mtx and Remicade) with no issues what so ever for 2 years.

T just started Mtx as mono therapy and two weeks in and no issues. Some fatigue but nothing awful and first blood tests just returned very good.
01-31-2015, 09:33 PM   #21
Lady Organic
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im curious to know what are the MTX dosing for children as mono therapy or in combo therapy? I was at 20mg when I tried it last year. maximum dose could have been 25mg/week.
02-01-2015, 08:42 AM   #22
crohnsinct
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Vaires pretty widely and I think depends on what other conditions have to be managed (joint, skin etc) but my daughter on combo therapy is at 10mg of Mtx with Remicade and my daughter on mono is at 20mg. A few of the teens here have been at 25mg of mtx and if I am not mistaken Clash's son did that level with Remicade.
02-01-2015, 10:03 AM   #23
Clash
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Yep, if I remember correctly we started lower and worked up to 25mg then at some point moved back down and it was in conjunction with remicade. Now C is on 10mg mtx by shot and hopes to start humira soon.
02-01-2015, 10:16 AM   #24
my little penguin
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DS was on 15 mg as mono therapy by injections ( which is absorbed more )
Later he was placed on 7.5 mg Mtx orally for arthritis combined with humira
It was raised to 12.5 mg of oral Mtx with humira for his arthritis
02-01-2015, 11:56 AM   #25
Maya142
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M has been on anywhere from 10 to 25mg (by injection) with Humira/Remicade.
Never done MTX as a monotherapy.
02-01-2015, 12:07 PM   #26
Farmwife
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Grace started when she was 4ish almost five, her dose was .30 but now .40 with Humira/ Remicade.
02-05-2015, 09:47 AM   #27
Lauren77
 
Join Date: Jan 2015
Location: Rockland County, New York
Sorry I'm chiming in so late! My DD starts the MTX (oral) and Humira next week and the dose she will max out on is 12.5 mg (they'll slowly increase over a few weeks). She needs to take the pills on Friday nights and 30 min. prior, she'll take Zofran to prevent nausea. Upon waking, she'll take another Zofran. Since she had the reaction to Remicade, she will need to have the Humira injections at the hospital until they can establish that she's ok to do it at home.

Initial 4 injection loading dose and subsequent q 2 week administration thereafter.

Still asymptomatic with normal baseline bloodwork - inflammatory markers and liver panel all normal. Don't want to jinx anything by even typing this but how the hell is she still in remission even though she hasn't had a Remicade infusion since October 21, 2014 with no other meds except for supplements and probiotics? I am thanking my lucky stars, praising Jesus, Buddha, Allah and any other higher power I can think of!! Hoping she does well on Humira & MTX and pray the same for all of your babies
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