Amgevita with Methotrexate: Triple therapy has failed... - NRAS


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Amgevita with Methotrexate


Triple therapy has failed to control my RA and I have just had my 1st injection of Amgevita. I was surprised to learn from the consultant that they want me to take Methotrexare as well. No studies have been done but it has been noted that statistically patients on the double therapy have a longer lasting settled period. It is thought that MTX stops or slows the body from developing antibodies to the biologic.

Is anyone else on double therapy and what has been your experience?

19 Replies

Yes, I was told and have read the same about MTX helping stop you developing antibodies to the biologic. I am about 16 months in to taking a biologic and we have got my MTX down to 15mg. The aim is to get down to 10mg.

I had terrible side effects to MTX so we discussed and compromised on 7.5mg though he wanted to start at 10mg. I'm just hoping the side effects are less with the lower dose.

Amy_Lee in reply to Sockknitter

I used to have a lot of side effects with mtx. The uneasy stomach feeling and vomiting stopped only when mtx down to 7.5 mg.

This is also what I have read that lower dose less side effects with Mtx.

Agoodlife in reply to helixhelix

I have understood that the immunosuppressive effect of the biologic is not strong enough and Mtx is complementing the effect of the biologic.(?)

helixhelix in reply to Agoodlife

Not what I’ve read. Biologics compromise the immune system more than MTX (in the doses we take. 🤔

My RA doctor said methotrexate caused my immune system to be compromised. I was having many many infections and he said it was a direct cause of the methotrexate and he took me off of it for a few weeks and then I started back on it along with orencia as he said orencia was not as immuno suppressive as the methotrexate and maybe between the two it would be better. So far so good for me.


I have been taking MTX and Leflunomide together for around 15 - 20 years. My RA was well controlled then I got cancer so had to stop MTX while I had chemo. Afterwards I found out I had Vasculitis so added Pred. Then got Osteoarthritis and Osteoporosis. Still taking Leflunomide with a lower dose MTX along with Pred. I expect I'll stay on them forever now.

Yes I take amvetiga with mtx and sulfasalazine. Started the biologic in October and slowly reducing prednisalone andno side affects so far,so time will tell.

I’m on Amgevita alongside Methotrexate 20mgs,doing well and looking in March to drop down on the methotrexate xx

I couldn’t tolerate MXT but my Rheumatologist said it would be fine to take the biologic with a different DMARD so I take it with Leflunomide and Sulphasalazine.

Hi there 😊

My Rheumatology consultant has approved and I'm also waiting to start biologics

The drug they suggesting is

Adalimumab, also to take 10mg methotrexate. I've negotiated starting on 7.5mg for first 4wks.

I've always had horrible side effects from Mtx Which I have taken on and off for 10yrs. When I was diagnosed with aggressive RA, although I have had periods of remission!

All the best and happy New Year to all


I’m on methotrexate and it no longer works . I have tried Hydroxy and sulfasalazine along side methotrexate but I’m allergic to both so am about to start entancept soon . I’ll be on 20mg methotrexate injections as well. I think double/triple therapy is quite common.

precious123 in reply to J1707

Double therapy is working for my fatigue for sure. I still have a good amount of pain and my sed rate is still high but not as high as it was. The methotrexate and orencia seems to be working and I’m greatful for any results. I’ve been bad for almost 4 years now. Nothing has worked but I’m praying this will be the ticket. If it wasn’t for pain management and the meds they give I don’t know what I would have done. I’ve had lots of stress in the last 4 years. My husband grandbaby and my mother all have passed away with my mother just two months ago. So lots of emotional stress. I know that plays havoc on your body. Plus I’ve been working for 3 of those 4 years trying to get my disability. Hearing is feb so I got that to deal with as well. Ohh how I’m praying this new year is better. Sorry for going on. I hope you all have a wonderful day. Hugs to all.

J1707 in reply to precious123

Don’t say sorry we all need to be listened too and sometimes just saying it lifts the burden.

Next year WILL BE A GOOD YEAR....🍾

precious123 in reply to J1707

Yes I’m praying so. Thanks for listening to me ramble. Lol

Hi Sockknitter. I was searching NRAS for posts on Amgevita And found yours from a few months back. After 2 years on MTX with good but not sustained improvement (up and down a lot ☹️) my consultant is about to start me on bi-weekly Amgevita injections as well as my weekly MTX injections. I’m hopeful but very nervous....just wondered how are you getting on with this combination? Has it improved things for you and have you noticed any side effects?

Hi Cagneysmum, I have been on the combined MTX and Amgevita since December. The MTX is there to stop my body developing antibodies to Amgevita so hopefully it will work for much longer. MTX dose is only 7.5mg so side effects are negligible. Amgevita is taking the strain and coping well. I have an ongoing very small amount of stiffness/pain in my fingers and I had a flare for 4 days when my feet were killing me. If not for Covid, I suspect my MTX dose would have been increased to 10mg but I'm not keen to rock the boat just now.

I originally thought that I had no side effects from AGV but discovered in February that my BP was up substantially. (1 in 10 people on AGV) GP arranged for Amlodepine tablets for blood pressure and it has calmed down.

I've also noticed that I have had blocked nose type symptoms as a side effect of the BP tablets. You can't win, eh!

Injecting into my stomach is painless as long as you allow AGV to warm up before injecting. Occasionally I get a small nettle rash around injection site. Try not to scratch.

All in, I have not felt this good and settled for a number of years. My activity levels are good and I no longer worry, indeed think about, my RA. Fingers crossed that it stays like this for a good number of years.

That’s great to hear. So glad it’s worked for you and hopeful it will do the same for me. Thanks 😀

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