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Methotrexate with Remicade

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Ulcerative Colitis
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Posted 11/3/2015 7:55 AM (GMT -6)
My GI has been nagging me to start Methotrexate injections once a week to ensure I do not develop antibodies to the remicade. I am doing very well. I have 3-4 bowel movements a day now without any blood. My inflammation markers are all down and my energy level is improving.

Has anyone had success with Methotrexate? The reviews are not exactly stellar. I went and got a second opinion from a very reputable GI who advised me that the research simply does not support its efficacy in extending the life of remicade. At the same time, my GI is at Mass General and his higher up with lots of experience treating UC are recommending Methotrexate. I am so torn. After taking 6 double doses of remicade, I finally feel like I am getting my life back. The side effects of remicade have been minimal. I don't want to mess with anything! And I have two small children and a very demanding job. I can't take something that is going to make me sleep all day.
Posted 11/3/2015 9:44 AM (GMT -6)
Ask if you can do imuran or 6mp. If not methotrexate has been good for some people.
It is however one of the two ibd medicines that you cannot get pregnant on or take while pregnant.
Imuran /6mp can be taken while pregnant
Posted 11/3/2015 9:48 AM (GMT -6)
I took it for a while but I had a much different situation. I wasn't a responder to remicade so i think there was hope that maybe I would respond to the MTX, which I didn't. Why MTX for you and not 6mp or imuran? I had already failed 6mp... I took pills for MTX. I wouldn't personally recommend it if you don't feel that it's going to help you.
Posted 11/3/2015 10:53 AM (GMT -6)
I tried imuran and it made my urine turn brown and messed with my kidney and liver. I also lost half my hair on it. If imuran is the lighter weight drug, I can't wait to see what MTX does. I have heard of people taking MTX to try to get a flare under control but it seems pointless when I am doing well. I realize that the remicade will fail....eventually. But I don't want to torture myself to get an extra year or two. Seems like a bad trade off. Unless I am overestimating the side effects of MTX?
Posted 11/3/2015 11:00 AM (GMT -6)
MTX can make you lose your hair too. I'm not saying it will happen but it can.

Have you had your Remicade Antibodies tested? I'd start there first before making a decision on adding another drug.

When I took Remicade there wasn't as many biological options for UC patients. There are 3 or 4 other biologicals available.

Are you getting an IV steroid with the Remicade? Some people get one dose with the IV which can help with antibodies.
Posted 11/3/2015 1:06 PM (GMT -6)
Just to clarify, Many patients and even some doctors believe that some of the medications cause hair loss. However, there have been very legitimate studies showing, that about 90 to 100 days after inflammation (elevated crp,fcp,esr...).patients begin to lose copious amounts of hair. Many doctors will mistakenly withdraw the medication as hair loss is not something patients are willing to deal with. Occasionally, some medications can cause hair loss but usually it is due to the inflammation (chemotherapy). However, if you had brown urine with Imuran then it is not a wise idea. The tests for antibodies and absorption are both good idea. Also, you can try steroids with each infusing to help prevent antibodies. Good luck.
Posted 11/3/2015 3:44 PM (GMT -6)
My 9 year old daughter has been on Methotrexate pills (7 of them) for over a year now. She was prescribed them because of secondary problem related to UC, arthritis in her joints. So far no side effects at all. We are actually in the process of tapering down MTX (5 at the moment). I think the doc's will stop at some point and she may continue some numbers of pills for some time to come..
Posted 11/3/2015 4:37 PM (GMT -6)
I switched to an academic IBD specialist a year ago. I was started on remicade in 2009 by a private practice doc and we never talked about adding a med to prevent antibodies. When I met with my new doc and asked him about it, he said it wasn't necessary. He does research and is from the University of Pittsburgh Medical Center.
Posted 1/31/2017 5:44 PM (GMT -6)
My doctor has also suggested adding methotrexate to Remicade. As a young male, thiopurines are pretty much out of the question--not really willing to accept a higher risk, albeit still pretty small, of hepatosplenic t-cell lymphoma.

Just seeing if you decided to follow through with the methotrexate and if so, how you have responded to it.

I'm also wary of adding methotrexate, especially since I saw a study that suggested methotrexate + Remicade was no more effective than Remicade alone in patients with Crohn's. I realize the success of treatments differs in Crohn's and UC, but I'm worried I would be taking on additional risk by adding methotrexate with little to no benefit. My doctor recommends it, so I don't know if this is one of those times where I just trust my doctor. It's tough for me to trust him, since I just started seeing him and he's not the one taking the methotrexate either.

Any thoughts or advice?
Posted 1/31/2017 10:23 PM (GMT -6)
I take Remicade. I had 2 infusions then had my antibodies tested..they were high. Started methotrexate and they went to 0. One year later developed stricture, missed Remicade infusion, had surgery (colostomy), had Remicade infusion at 14 weeks out, tested for antibodies-they were high again-went back on methotrexate and antibodies are back down to 0.

Both times my antibodies were high my jaw started hurting.

Unsure if it is for you. For me...it seems to be working.

Clo
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