Two TNF-alpha meds?

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Sarah_B
Regular Member


Date Joined Feb 2009
Total Posts : 82
   Posted 3/25/2010 10:06 AM (GMT -7)   
I was wondering if anyone knew whether or not using two TNF-alpha blockers simultaneously was ever explored as a possibility. Like, if one immunosuppressant alone (or along with other kinds of immunosuppressants) didn’t cover all of your autoimmune issues and you took another TNF-alpha blocker to cover the remaining problems.

I started thinking about this because I have had uveitis for a few years and I am currently struggling toward an ankylosing spondylitis diagnosis. I have been on Humira, Cimzia and Remicade while dealing with uveitis, none of which has been able to completely control it (though right now, Remicade and 6-MP seem to be keeping it at least manageable). Also, I have been having chronic back pain and stiffness for a while, which my doctors are going back and forth on as far as AS goes. I know that biologics like Enbrel and Simponi are approved for AS, but not for Crohn’s.

I’m rambling a little bit, but I guess my question is if someone has multiple autoimmune disorders (like Crohn’s and RA or AS or uveitis or psoriasis) that weren’t all controlled with one medication alone, do you think it would be possible to be on two at the same time? I realize insurance would likely not cover it, but I’m curious nonetheless.
22 years old, Female.
Diagnosed with Crohn's Ileocolitis November 2008.
Currently taking Remicade, 50 mg 6-MP.


1asalsa
Regular Member


Date Joined Feb 2010
Total Posts : 40
   Posted 3/25/2010 2:27 PM (GMT -7)   
I also had uveitis (iritis) last year right before a really bad flare where I ended up in the hospital for a week. My eye has never gone back to normal, although they say the uveitis is gone, and there are no cells visible when they look at it with the slit lamp. I can't focus right anymore, and my eyes get really dry and tired. Then they were talking about possible ocular myasthenia gravis and SJogren's syndrome. I am currently on Remicade (was also on Imuran at the same time, but had to get off Imuran because the liver tests got elevated) and taking Restasis for really dry eyes; also have punctal plugs. Ever since the uveitis, I have not been able to wear my contacts for any length of time, and it is making me crazy because my vision is so bad. Imuran or 6 MP will prevent the uveitis from recurring, so I guess you are on 2 different meds already for the autoimmune diseases, just not 2 alpha TNF blockers. Don't the TNF blockers treat multiple conditions? My friend who has RA takes Remicade for that, and I thought it was supposed to help AS, too.. Can you tell me more about your uveitis? How long did it last, and did it permanently affect your eyes?

PV
Veteran Member


Date Joined May 2006
Total Posts : 1177
   Posted 3/25/2010 6:18 PM (GMT -7)   
I'm sorry you're having such a rough time. I haven't heard of anyone getting 2 anti-tnf agents together. I don't know if the interactions between the drugs has been studied to know what the side effects would be . . . ie. I don't think there have been any studies of patients taking both remicade and humira together, so I doubt a doc would prescribe that. I'm sure others will correct me if I'm way off base here.

On another note, my husband's rheumatologist really like methotrexate for RA/joint pain. She seems to believe it works better than 6-mp or Imuran for arthritis, though I'm sure it depends on the individual as well. My mom has RA, and she is on MTX with really good results. Would a short course of pred help? Sorry that I have no better suggestions.

I hope you find some relief soon.

PV
Husband with Crohn's
Diagnosed March 2003 Ulcerative Proctitis
Diagnosed March 2008 Crohn's & C-diff, hospitalized 45 days
Crohn's in Remission since June 2008
C-diff recurrence Sep 2009
Reactive Arthritis Nov 2009
Currently c-diff free
Osteopenia of spine (Mar 2010)
Canasa (1gm), Lialda (4.8 gms), Remicade (8 weeks)
Currently In Remission


Sarah_B
Regular Member


Date Joined Feb 2009
Total Posts : 82
   Posted 3/29/2010 12:30 PM (GMT -7)   
1asalsa, I’m sorry to hear your vision is not back to normal. Did you need any treatment during your flare? Some of the treatments can cause a change in vision themselves. I had a problem with focus for a few weeks to a month after the cryotherapy I had, but it eventually cleared up. I’m guessing you’ve had your eyes checked for astigmatism or a change in prescription if they’re already moving on to ocular myasthenia.
 
Remicade is approved to treat AS, I believe, but unfortunately whatever is going on with my back isn’t letting up and I can’t honestly say my eyes are 100% either.

My uveitis started about six months after my Crohn’s symptoms did. It began with excessive floaters and flashes in the side of my vision. At the time, it wasn’t too bad and it was only affecting my left eye, so we didn’t start any sort of treatment. Almost exactly a year later, it started flaring. The vision in my left eye was extremely cloudy and I could barely see anything out if it. At that point, we started steroid injections, but within a week my right eye became affected and began to hemorrhage. I lost 90% of my vision, which was really scary. 60 mg of prednisone and about a month later, my vision was almost back to normal.

Right now I am ok, so long as my vision stays where it is. If it weren’t for the uveitis, I’d still be nice and happy on Cimzia without the Remicade and 6-MP and all the nausea and hair loss it brings. I’m grateful I have my vision back, but it would be nice if nothing had changed and if I had stayed the way I was before the flare.
22 years old, Female.
Diagnosed with Crohn's Ileocolitis November 2008.
Currently taking Remicade, 50 mg 6-MP.


Sarah_B
Regular Member


Date Joined Feb 2009
Total Posts : 82
   Posted 3/29/2010 12:38 PM (GMT -7)   
PV, thanks for the response. Yeah, I was mainly curious if anyone knew of any studies done, as I haven’t heard of any either. I’m actually seeing a rheumatologist in a few weeks, so I’ll ask him if he would recommend switching to methotrexate. As for prednisone, I was actually on 60 mg daily when the pain started. Though, to be honest, even though the pain is pretty excruciating most of the time, it’d take a lot of convincing to get me to go back on pred again anyway. It took me going blind last year to finally agree to try it again lol. And I’m still feeling the ramifications of it. I’m glad to finally be off it now. Six days and counting; keep your fingers crossed!
22 years old, Female.
Diagnosed with Crohn's Ileocolitis November 2008.
Currently taking Remicade, 50 mg 6-MP.


beave
Veteran Member


Date Joined Mar 2007
Total Posts : 1091
   Posted 3/29/2010 2:53 PM (GMT -7)   
Sarah_B,
I've been to a few conferences on IBD and heard many talks about treatment with combinations of TNF-alpha blockers in combination with other meds (like pred, imuran, methotrexate). But using two TNF-alpha blockers at once never came up, not even in passing. I'd venture to say there's nothing gained by doing two at a time.

medieval_peasant
Regular Member


Date Joined Mar 2009
Total Posts : 52
   Posted 3/29/2010 8:30 PM (GMT -7)   
I spoke with a lead researcher, Dr. Fernando Velayos of the University of California-San Francisco, and he told me that researchers are looking at the possibility of combination therapy using more than TNF blocker in IBD. For example he mentioned the use of Natalizumab combined with Infliximab (remicade), certolizumab (cimzia), or adalimumab (humira). You may want to contact him with your question. here is a link to his info page: http://gidiv.ucsf.edu/gidiv/people/velayos.pdf

Sarah_B
Regular Member


Date Joined Feb 2009
Total Posts : 82
   Posted 3/30/2010 7:39 AM (GMT -7)   
Thank so much, medieval_peasant!
22 years old, Female.
Diagnosed with Crohn's Ileocolitis November 2008.
Currently taking Remicade, 50 mg 6-MP.

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