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Is combination therapy still relevant?

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73monte
Veteran Member
Joined : Mar 2007
Posts : 2449
Posted 5/18/2021 1:01 PM (GMT -8)
By Daughter has done pretty well over the last 10 years on Remicade and Imuran. At the time that she started this combination, the school of thought was that an additonal immuno would assist in preventing antibodies to an anti-TNF.

Prior to Remicade, she was on Imuran exclusively for about 2 years, but never felt like she did well on it, and felt some annoying unpleasant side effects.

After a consult with her GI today, she decided to take her off of Imuran altogether now. She really didn't mention anything to her about antibodies, just that she felt she would continue to do fine on Remicade alone.

Anyone have any input on this, or thriving on just an anti-TNF without any other meds?
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straydog
Forum Moderator
Joined : Feb 2003
Posts : 19419
Posted 5/19/2021 4:18 AM (GMT -8)
It's a mixed bag, not all drs put their patients on Imuran with Remicade & Humira. I have been seeing drs take patients off Imuran after being on it for several years with Remicade & they did ok. Hopefully your daughter will be fine without it.

Good luck to your daughter.
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clo2014
Veteran Member
Joined : Feb 2015
Posts : 1909
Posted 5/19/2021 7:02 PM (GMT -8)
I am still on Remicade and Methotrexate. 6 years. No antibodies as long as I take the MX. I have begged to be taken off the MX but GI said no. He thinks you need the dual therapy to ensure you do not build antibodies. I actually shopped my GIs answer with 2 other GIs and they both recommended I stay on dual therapy.

A lady in one of my support groups with Crohns disease stopped taking her MX and continued with her Remicade infusions. Last week she ended up in the hospital due to a reaction during her infusion.

But....if you are younger, haven't had any issues.....you may be able to do it. Another lady in our support group stopped her dual therapy over 10 years ago...and she's still taking Remicade and its working.

So I am unsure.

Has your daughter had any tests to show antibody levels? Is that something they can do to monitor it? I don't know if Imuran will drive antibodies down once you develop them.

I do know that with MX there is a small group of people that it will drive their antibody level to zero even after they have developed antibodies. Its done it for me twice. I had stopped taking it due to surgery and then shingles. This surgery I did not stop it....so I am still at 0.

I wish your daughter good health and good luck. Please keep us updated.

Clo
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73monte
Veteran Member
Joined : Mar 2007
Posts : 2449
Posted 5/20/2021 4:41 PM (GMT -8)

clo2014 said...
I am still on Remicade and Methotrexate. 6 years. No antibodies as long as I take the MX. I have begged to be taken off the MX but GI said no. He thinks you need the dual therapy to ensure you do not build antibodies. I actually shopped my GIs answer with 2 other GIs and they both recommended I stay on dual therapy.

A lady in one of my support groups with Crohns disease stopped taking her MX and continued with her Remicade infusions. Last week she ended up in the hospital due to a reaction during her infusion.

But....if you are younger, haven't had any issues.....you may be able to do it. Another lady in our support group stopped her dual therapy over 10 years ago...and she's still taking Remicade and its working.

So I am unsure.

Has your daughter had any tests to show antibody levels? Is that something they can do to monitor it? I don't know if Imuran will drive antibodies down once you develop them.

I do know that with MX there is a small group of people that it will drive their antibody level to zero even after they have developed antibodies. Its done it for me twice. I had stopped taking it due to surgery and then shingles. This surgery I did not stop it....so I am still at 0.

I wish your daughter good health and good luck. Please keep us updated.

Clo

Thanks for the detailed reply Clo,

Her GI didn't recommend any testing for antibodies, which I found sort of odd as well. They did a conference call, and went over her recent blood work. Based on where she's at right now, and her blood work was perfectly normal in every area except iron, which has been a constant problem. I think her decision to stop the Imuran, was based on her age. Didn't want her taking it for years to come. Didn't seem to have that concern with Remicade at all.

Hoping for the best right now. Thanks again, will keep updated.
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Coffiend
Regular Member
Joined : Jun 2021
Posts : 38
Posted 6/24/2021 8:27 AM (GMT -8)
I know this thread's a little old, but just thought I'd give my two cents. I've asked several specialists about this topic, and though opinions differ, the consensus seems to be that the highest risk of developing antibodies is at the beginning of treatment. So combination therapy is still extremely common, but after a year or so, many people also discontinue with the additional immunosuppressant. I was taking a similar combination, but now, only the biologic. I seem to be doing okay, although dosages may have to be adjusted in the future. However, this was preferable for me because I experienced unpleasant side-effects of immunosuppressant use.
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73monte
Veteran Member
Joined : Mar 2007
Posts : 2449
Posted 6/24/2021 4:03 PM (GMT -8)
Thanks Coffiend,

That's very helpful information, as even though it's been several months now without any apparent issues, I still of course worry. Your post offers some reassurance, thanks again.
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Coffiend
Regular Member
Joined : Jun 2021
Posts : 38
Posted 6/24/2021 5:22 PM (GMT -8)
No worries - even if the worst happens, switching biologics down the road isn't always a big undertaking.
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DCCrohns
Regular Member
Joined : Jul 2011
Posts : 60
Posted 6/25/2021 2:17 PM (GMT -8)
I was just discussing this with my GI doc. I have had to switch biologics several times after not responding or, for Remicade, developing a reaction. I have been on Imuran with Stelara for years but she mentioned perhaps removing the Imuran based on more recent research. Just had blood drawn to check levels of Stelara, Imuran and antibodies so we'll see. I'd rather been on less meds but always afraid of sliding back and not being able to get back to where I am (even if not perfect).
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scifigal2k
Veteran Member
Joined : May 2012
Posts : 3689
Posted 6/26/2021 7:46 PM (GMT -8)
I started out on Imuran and Mesalamine. They didn't do much and I developed an abscess that turned into a fistula. I started Remicade and got pancreatitis around the same time, which they attributed to a rare side effect of imuran. They took me off both, but since Imuran stays in your system so long (I think like 6 months?), the pancreatitis took that long to subside (spent most of it in the hospital and on a feeding tube).

But that was over 9 years ago that I started Remicade. I'm still doing great on it, even at a double dose of 10 mg/kg every 6 weeks.
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EruditePaul
Veteran Member
Joined : Jan 2006
Posts : 568
Posted 6/27/2021 6:51 AM (GMT -8)
Wow. I have latent TB, but I have heard about Imuran, and I know it is safe to take Imuran even if I have latent TB. So for years I have dreamed about taking Imuran if my Chron's gets aggressive and out of control. From reading the above posts, taking Imuran is not like a walk in the park. Fortunately, I have not taken Imuran so far.
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minnietoty
Veteran Member
Joined : Dec 2010
Posts : 3073
Posted 7/23/2021 6:19 PM (GMT -8)
I have been on this combo for almost 4 years since I started Remicade. When COVID-19 broke out last year, my GI decided I should stop taking Imuran for fear that the combo might weaken my immune system. A week ago, he prescribed it again in addition to Remicade as I’m in the middle of a flare up. He mentioned that it’s fine to re-take Imuran given I had two coronavirus infections when I was off of it.
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