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Crohn's Disease Forum » Treatment » Remicade/Infliximab » Doctor Recommending Adding Methotrexate to Remicade


02-01-2016, 10:32 PM   #1
Sonnyboy66
 
Join Date: Jan 2016
Location: Oakdale, New York
Doctor Recommending Adding Methotrexate to Remicade

Our 10 year old son was diagnosed with Crohn's disease in the ileum Thanksgiving, 2015. He has had two infusions of remicade and has had no recent symptoms. He is down to 5 mg of prednisone every other day, with the last dose due a week from tomorrow. All his blood tests have shown that his inflammation numbers have returned to normal. Today we had an appointment with the GI doctor who mentioned doing blood tests 4 weeks after his next remicade on 2-8-16, to determine how quickly the remicade dissipates in his system. Then the doctor mentioned possibly adding methotrexate to the remicade to prevent his body developing anti-bodies to the remicade.

What we are concerned about are the side effects from the methotrexate? The CCFA website notes that this causes birth defects and should not be taken by those who plan on getting pregnant, either males or females. As he is still developing will this affect him in the future?

We are concerned.

__________________
Son diagnosed with moderate/severe Crohn's disease on November 22, 2015. Age 10.

Current treatment:
Remicade (1st infusion 12-29-15);
Prednisone: 20 mg (reduced from 40 mg);
Ranitine: 150 mg 1x/day.

Previous treatment:
NG tube: 11-22-15 to 11-24-15;
Prednisone: 40 mg via iv;
anti-biotic via iv (5 days);
Fluconazole: 100 mg 1x/day for candida overgrowth

Medications:
Multi-vitamin

Sonnyboy66 is online now Report Post
__________________
Son diagnosed with moderate/severe Crohn's disease on November 22, 2015. Age 10.

Current treatment:
Remicade (1st infusion 12-29-15).

Previous treatment:
NG tube: 11-22-15 to 11-24-15;
Prednisone: 40 mg via iv;
anti-biotic via iv (5 days);
Fluconazole: 100 mg 1x/day for candida overgrowth

Medications:
Multi-vitamin;
Vitamin D- 1,000 IU 2x/day
Miralax 1x/Day
02-18-2016, 08:25 AM   #2
Silverbird
 
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Join Date: Oct 2015
Location: The Netherlands

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Mmm, no replies yet?

Sorry to hear about your son's diagnosis!

Interesting your son's doctor immediately wants to add methotrexate to the Remicade treatment. It is definitely common to add an immunosurpressant to treatment with biologicals, but as far as I'm aware, methotrexate is usually not the first choice, it's pretty heavy stuff.

I'm not sure if you've already made the decision, but it could be an option to ask the doctor why your son shouldn't start with azathiorpine or 6MP (I believe 6MP is the most common drug to take in combination with Remicade), instead of Methotrexate.

(I feel I should add though: also the possible side effects for azathioprine and 6MP sound very heavy, but the chances of the most severe side effects actually happening (like lymphoma, etc.) are incredibly small. These drugs are also taken after transplantations (azathioprine) and leukemia (6MP), in MUCH higher doses than one with IBD would get, that's where most of the described side effects come from!).

Good luck!
__________________
Crohn's disease since Dec 2012 | Perianal abcesses & fistula since June 2009

Remicade 300mg/6weeks | 6MP 25mg & Allopurinol 100mg every other day
02-18-2016, 08:39 AM   #3
Clash
Forum Monitor
 
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Since your son is a young male the GI probably opted for methotrexate over the thiopurines because recent studies have shown the cancer risk is greater with them and higher among young males. Some GIs are now trending toward methotrexate as the immunosuppressant rather than the thiopurines, 6mp and imuran, for this reason.

Since all 3 are all immunosuppressive meds and on the same tier of the treatment pyramid used with CD you aren't getting a more serious med than the other two.

As far as the birth defects, it is true that if the patient is trying to get pregnant then they should avoid taking methotrexate. It's also advised to come off this med for some time (I think 6 mos)before attempting pregnancy.

My son was dxed at 15 and placed on remicade. We added oral methotrexate about 3 months in. He's moved on to humira now but still takes methotrexate now in injection form weekly and he is 19.

I'll tag other parents who've had experience with mtx

my little penguin crohnsinct Maya142 I'm sure others will be along as well.
__________________
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
02-18-2016, 10:21 PM   #4
FrozenGirl
Senior Member
 
FrozenGirl's Avatar
I'm on MTX and Remi. Started on it after I had to stop Imuran and Remi due to side effects. It works decently well and can help prevent antibodies. With the injectable form I had nausea whereas with the oral form I had serious day after fatigue

In terms of pregnancy it doesn't affect future fertility. It is reccomended that you stop MTX for 6+ months before trying for a baby/having sex. Many doctors will require sexually active patients to use 2 forms of birth control or remain abstinent.
__________________
Dx: Ulcerative Colitis, Nov 2013
Currently on:
Mezavant 4.8g
Vitamin D 1000iu
Calcium
Tecta 40mg
Remicade: 600mg, every 4 weeks
Methotrexate: 15 mg (injection)
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Crohn's Disease Forum » Treatment » Remicade/Infliximab » Doctor Recommending Adding Methotrexate to Remicade
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