Unable to tolerate methotrexate

[EmJ79]

I’m unable to tolerate methotrexate due to deranged LFT’s. I was on methotrexate and imraldi.

I’m now on baricitinib as a mono therapy.

Had anyone else had any experience of being on just one medication and how has it been?

Thanks 😊

[Madmusiclover]

I’m on Baricitinib alone. I would say I’ve got 70-80% of my old self back. I’m happy on it but watch out for pesky chest infections in first year. They clear up but you have to stop drug whilst it does. In short not perfect but a life changing result.

[EmJ79 in reply to Madmusiclover]

Thanks. How long do you think it took to be fully effective?

[Madmusiclover in reply to EmJ79]

Baricitinib? For me a couple of weeks but we are all different!

[ATSF in reply to Madmusiclover]

I have been tried with MTX four times, each time failed to work and loads of side effects. My wife and a sister in law have been taking it for quite some years with no problems and great effect.

[AgedCrone]

I have always been on monotherapy for 20+ years….& seem to have had far less side effects than I read others have when taking multiple drugs.So if it works for you…stick with it.

[Lolabridge]

I am on monotherapy, currently Imraldi (Adalimumab) but was on Rituximab (or one of its biosimilars) before that, because I had adverse reactions to Methotrexate, sulfasalazine and hydroxychloroquine. The Rituximab worked well on its own but I've only had my first three doses of Imraldi so it's not yet working fully. I hope it will soon 🤞 as I'm having to take an 8-week taper course of prednisolone meanwhile.

Hope the Baricitinib will work well for you.

[EmJ79 in reply to Lolabridge]

How come you stopped the Rituximab? I was on imraldi too, not sure why they swapped me to Baricitinib I thought because imraldi wasn’t used on it’s own?

[Lolabridge in reply to EmJ79]

Yes Imraldi can be given as monotherapy. My consultant was concerned that my immune system (B cells) had been much depleted by the Rituximab infusions and we’re hoping it will recover somewhat whilst I’m on Imraldi which is an anti-TNF and works in a different way.

[EmJ79 in reply to Lolabridge]

Wow, I’ve got so much to learn about all these medications….. I’m a nurse and still don’t really have a clue what I’m putting in my body 😂I would say I was better on Imraldi, well it certainly took effect quicker than Baricitinib.

[Hidden]

Was on mtx as monotherapy initially before adding leflunomide, but mtx never did anything at all for me. Stopped mtx after 13 months and spent a short while on lef as a mono, but my liver pitched a fit putting the dose up and took ages to get happy again. Once my liver finally calmed down and I was allowed back on any meds, I had a 4 month spell just on imraldi. Now taking imraldi, a pointlessly low dose of lef, and an 8 week course of steroids whilst waiting to hear what next, but potentially etanercept as a mono.

Although many do take mtx (or occasionally another conventional dmard like lef if you have problems with mtx) alongside some biologics, quite a few can be used on their own. My understanding is adding one in is not generally done for the same reasons that multiple dmards are taken at once, though, where it’s for the combined effect e.g. taking mtx with both hydroxy and salfasalazine. Using something like mtx with a biologic has a couple of benefits, but as I understand things, it’s primarily to prevent the immune system from binding to the biologic and trying to get rid of it as an ‘invader’. The mtx makes the biologic more effective by suppressing the immune system, although if the mtx works for you as a drug, you’re potentially going to get some benefit that way, too.

[EmJ79 in reply to Hidden]

Thank you, that’s a clear explanation. I’m still getting to grips with it all to be honest.I was nice and stable on imraldi and methotrexate until I had a serious of infections requiring 3 x AB’s to clear. Then my liver went a bit crazy. Then I got covid…..

Now trying to get back o track with Baricitinib.

I’ve had really bad leg pain since December, not my joints it’s really strange?

[aliplayspiano]

Yes I just take tocilizumab as a monotherapy. I was told by the consultant that the reason he prescribed it for me was because it could be taken alone without having to take methotrexate alongside it as the meth made me feel really sick.

[Hidden]

I haven't been able to take Methotrexate for 20 years because of elevated LFTs. Currently on Tocilizumab, with a close eye on my liver. I had to withhold it for 8 weeks after contracting covid as it also sent my liver off on a tantrum.