My daughter Renee has been doing well on a 6MP / Remicade combo for several years now and is technically in remission. She does experience headaches and fatigue occasionally. Several months ago her 6MP dose was reduced from 100mg to 50mg/day. Recent blood tests show no Remicade antibody development and great Remicade levels in her blood. Her GI thinks she is a good candidate to stop 6MP and just continue with Remicade. Has anyone had any experience running with the 6MP/Remicade combo then going off 6MP? Any advice?
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Stopping 6MP while continuing on Remicade
- Thread starter Ricky_V
- Start date
Our GI actually will not use 6MP and Remicade together at all because it is higher risk than MTX and Remicade (in terms of malignancies - the very rare hepatosplenic T cell lymphoma was mostly male adolescents and young adults, most on thiopurines and Remicade).
She will use 6MP or Imuran with other biologics if absolutely necessary. My younger daughter cannot tolerate MTX so she is on Imuran.
If your daughter doing well, you could definitely try it. My older daughter tries to wean herself off MTX almost yearly (she was also on Humira when she tried last) and unfortunately it always backfires and she flares.
I know there was another parent with a kiddo on Remicade + MTX, and her daughter flared after MTX was stopped.
Tagging pdx and crohnsinct.
She will use 6MP or Imuran with other biologics if absolutely necessary. My younger daughter cannot tolerate MTX so she is on Imuran.
If your daughter doing well, you could definitely try it. My older daughter tries to wean herself off MTX almost yearly (she was also on Humira when she tried last) and unfortunately it always backfires and she flares.
I know there was another parent with a kiddo on Remicade + MTX, and her daughter flared after MTX was stopped.
Tagging pdx and crohnsinct.
crohnsinct
Well-known member
Well you can't go by me because my older daughter started going downhill before she stopped Mtx BUT she definitely went faster and harder after she stopped mtx.
My younger daughter also stopped mtx around the same time and she is fine.
My friend's son went off mtx and after a number of months he started building antibodies. Once you build high enough antibodies you could lose the biologic. It would stink to lose a drug that works.
I could totally understand the reluctance to use 6MP/Imuran. Would GI entertain the use of Mtx?
My younger daughter also stopped mtx around the same time and she is fine.
My friend's son went off mtx and after a number of months he started building antibodies. Once you build high enough antibodies you could lose the biologic. It would stink to lose a drug that works.
I could totally understand the reluctance to use 6MP/Imuran. Would GI entertain the use of Mtx?
- Location
- New York, USA
When I first started Remicade I was also on 6MP...after a few years I was taken off the 6MP, and have been on only Remicade for probably 7+ years with no real issues.
My daughter is the one who flared after dropping mtx from her Remicade + mtx regimen. Her doctor checked her Remicade levels during the flare, and her levels were low and she had just started to develop Remicade antibodies. We put her back on mtx, but also raised her Remicade dose at the same time, and now she's been good again for a year, with sufficient Remicade levels and no antibodies.
I'm pretty confident that in my daughter's case, mtx acts as a boost to her Remicade levels. What I'm not so sure about is whether or not we could have gotten the same good results by just raising her Remicade levels up more without having to add back mtx. Crohnsinct's daughter's new GI believes this--that as long as you keep Remicade levels high enough, patients won't form antibodies.
I don't know which is better for long term health: using mtx + Remicade or just using a higher Remicade dose with no mtx.
In your daughter's case, if she does decide to drop Imuran, I would try to get her doctor to test her Remicade levels several times in the 6 months after dropping it, to make sure that her levels stay therapeutic and that antibodies aren't developing. She wants to find this out early, before the antibody levels get so high that she can't use Remicade any more. If she does see dropping levels, she might need to decide whether to add back an immunomodulator (which could be mtx), or just raise Remicade dose or frequency.
I'm pretty confident that in my daughter's case, mtx acts as a boost to her Remicade levels. What I'm not so sure about is whether or not we could have gotten the same good results by just raising her Remicade levels up more without having to add back mtx. Crohnsinct's daughter's new GI believes this--that as long as you keep Remicade levels high enough, patients won't form antibodies.
I don't know which is better for long term health: using mtx + Remicade or just using a higher Remicade dose with no mtx.
In your daughter's case, if she does decide to drop Imuran, I would try to get her doctor to test her Remicade levels several times in the 6 months after dropping it, to make sure that her levels stay therapeutic and that antibodies aren't developing. She wants to find this out early, before the antibody levels get so high that she can't use Remicade any more. If she does see dropping levels, she might need to decide whether to add back an immunomodulator (which could be mtx), or just raise Remicade dose or frequency.