Was Methotrexate a shielding medication?: Hi, I’m... - NRAS

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Was Methotrexate a shielding medication?

tils898 profile image

Hi, I’m pretty new to the site, and have just had my mediation changed from sulfasalazine to methotrexate, as the sulfasalazine had stopped being so effective, was just wondering, was Methotrexate a medication that would of highlighted you as vulnerable and placed you on the shielding list for COVID? I’m taking 15mg (tablet form) at the moment

Thanks

27 Replies

Not on its own it didn’t tils. These were the guidelines before shielding ended.

rheumatology.org.uk/Portals...

tils898 profile image
tils898 in reply to KittyJ

Thanks kitty

It really depends if you have anything else going on (co-morbidity).

I didn’t think shielding existed now?

tils898 profile image
tils898 in reply to helixhelix

No, I was just wondering if it placed me in the vulnerable group or not, as I work in a public setting, and was just concerned if my risk was greater, and if I would possibly get offered a 3rd vaccine if that’s the route it’s going

I think that the latest thinking is that they might be offering a 3rd vaccine to those taking more than 20mg Methotrexate; I'm currently on 20mg so I'm not expecting to be offered one but who knows?!

MadBunny profile image
MadBunny in reply to Boxerlady

I'm only on 10 so that counts me out 😟

tils898 profile image
tils898 in reply to Boxerlady

I’m increasing to 20 in 2 weeks, but they haven’t said any higher as yet, so probably not for me then either

Charlie_G profile image
Charlie_G in reply to Boxerlady

The JCVI advice is that those taking 20mg or more at the time of (or within the 3 months before) either their first or second jab should have a third vaccine, or those taking certain combinations of drugs, including mtx at any dose alongside leflunomide. The advice for who should have a third as it generally pertains to people here is:

‘3. Individuals with chronic immune-mediated inflammatory disease who were receiving or had received immunosuppressive therapy prior to vaccination including:

-high-dose corticosteroids (equivalent to ≥ 20mg prednisolone per day) for more than 10 days in the previous month

-long-term moderate dose corticosteroids (equivalent to ≥10mg prednisolone per day for more than 4 weeks) in the previous 3 months

-non-biological oral immune modulating drugs, such as methotrexate >20mg per week (oral and subcutaneous), azathioprine >3.0mg/kg/day, 6-mercaptopurine >1.5mg/kg/day, mycophenolate >1g/day in the previous 3 months

-certain combination therapies at individual doses lower than above, including those on ≥7.5mg prednisolone per day in combination with other immunosuppressants (other than hydroxychloroquine or sulfasalazine) and those receiving methotrexate (any dose) with leflunomide in the previous 3 months

4. Individuals who had received high-dose steroids (equivalent to >40mg prednisolone per day for more than a week) for any reason in the month before vaccination.’

Boxerlady profile image
Boxerlady in reply to Charlie_G

Thanks Charlie - I read that as "more than 20mg" but I'll wait and see if I'm called. I was on 25mg for a few weeks but that was after my two jabs. I'm pretty relaxed about it all, tbh. I'm continuing to be careful but have never shielded; I'm lucky in that all my work was online until recently and although some of it is in person now, it doesn't feel particularly risky.

Cavlover profile image
Cavlover in reply to Boxerlady

Yes I read it as more than 20mg. I am on 20mg too. However, there is also a mention of low lymphocyte counts so not sure if that will be taken in to consideration, but that probably applies to most of us. Interestingly the BSR website advises all patients taking DMARDs receive the third vaccination so will just have to wait and see what happens. I have been very careful and still wary of crowded places as had sepsis twice a few years ago and that was before I took Methotrexate. Know my immune system is not the best even in good times.

Personally I see it as a good thing if they don't think that I need another jab 😊

I’m not sure what exactly will happen. I’m on 15mg Methotrexate and 400 Hydroxy alongside the usual assortment anti inflammatory and high blood pressure pills- all came after RA diagnosis and meds. I got a blue NHS letter last month, saying I’m immunosuppressed and any children 12-15 years with whom I have regular contact were eligible to go for vaccine!

Not sure if this is only Scotland or UK wide but it sure makes you think doesn’t it! Anybody else had one of these? M x

My wife and a sister in law take Mtx. They gave both been classed as extremely vulnerable. I take Prednisolone and have also been classed as extremely vulnerable.

Boxerlady profile image
Boxerlady in reply to ATSF

I was classed as CEV too but I believe that it was "overkill" as according to most guidance I wasn't. I made the personal decision to be careful but not to shield as that felt right for me personally.

Good morning tils898, I was diagnosed with RA in Feb/March and finally got my meds - methotrexate in June, I've had no problems with it other than minor nausea after the first 2/3 doses, now I'm fine. Told it was my body adjusting. 🐕🐕

tils898 profile image
tils898 in reply to Ritaritis

Can I ask what dose your on? I’m having bad nausea for 2 days after taking it, I’m hoping it will settle down eventually

Boxerlady profile image
Boxerlady in reply to tils898

How much Folic Acid are you on? Mine was increased from once a week to six days a week (not on Methotrexate day) and that helped a lot with side effects.

It's also worth drinking lots of water for at least a day each side of your Methotrexate day. I find that peppermint and ginger (in all forms) helps with nausia as does eating little and often - preferably before I feel hungry.

tils898 profile image
tils898 in reply to Boxerlady

I’m on 6 days folic acid, I have bought some crystallised ginger to try this week, hopefully it will help

Boxerlady profile image
Boxerlady in reply to tils898

I drink peppermint tea and suck sugar-free Polos; I also eat ginger biscuits 😋

Ritaritis profile image
Ritaritis in reply to tils898

Hi, I take 15 mg weekly, don't know if this is high or not. Drinking ginger beer seems to help.🐕

I take Methotrexate and no additional medication for RA. I was sent a letter as an extremely vulnerable person and asked to shield.x

Flor1rence profile image
Flor1rence in reply to AKA13

hi same here, I take MTX for an autoimmune disease only 10mg in lockdown and now 15mg classed as CEV and asked to shield 😉

helixhelix profile image
helixhelix in reply to AKA13

It seemed a complete lottery as to how risk was assessed across the UK. Perhaps it was based on age or other comorbidiites?

I am just on MTX and a biologic and basically decided for myself not to shield.

I think if it is combined with a biologic medication it would make you vulnerable - but on its own and, depending on the dose, it comes under the "slightly" risky heading. I take 10mg weekly combined with Infliximab - so making me vulnerable. 10mg is considered a low dose.

In very high doses; for example when used for certain cancers, then it's another story.

It should be easy to find out where you are. There's plenty of information on the NHS sites.

Also, 15mg by tablets is not high, as a lot of that dose is not absorbed as it goes through the gut. so you will be absorbing much less than that. A much better absorption comes from subcut. injections.

Yes ,you are classed as vulnerable to infection as your immune system is comprised by the methotrexate. So you have low immunity compared to non RA people.Also the risk of lung problems on MTX is multiplied by the drug so a respiratory illness would be extremely severe.

I was on 20mg Leflunamide/day for last few years, with the RA 'inactive' and last year was still classed as 'vulnerable' re. the vaccines & government guidance here in Wales. (This year the RA is active again and meds not working!)

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