Antivirals with Filgotinib and MTX

[JulieMBrown]

Hi all I’m just wondering if anyone has continued taking MTX and Filgotinib while on antivirals. I’ve had an outbreak of cold sores that have completely covered my lower lip and am taking 5xAcyclovir tablets per day. I take 200mg of Filgotinib daily and 15mg MTX weekly. The doctor didn’t mention stopping these medications but I’m just wondering what others have done. Many thanks. Julie

[Madmusiclover]

I stopped taking all immunosuppressants when taking antivirals for Covid and Shingles.

[JulieMBrown in reply to Madmusiclover]

Thanks for this. I’m going to check with my GP and RA nurse tomorrow. Thanks for taking the time to reply.

[Amnesiac3637]

I’m on Filgotinib and have been told to stop for any infections that require antibiotic cover. Most people who are on Methotrexate are advised to do the same but antivirals are not antibiotics and you haven’t a systemic infection so the best thing to do is ask your pharmacist on Monday or your GP or rheumatology team if available. If your doctor didn’t mention stopping your drugs you’re pretty safe to continue but you could check if you think it’s necessary. Good luck with getting rid of the cold sores!

[JulieMBrown in reply to Amnesiac3637]

Thank you very much. It was an on call doctor based at our hospital. He said that he’d checked for any potential negative interactions between the antivirals and the Filgotinib / MTX and it was fine to continue with all medications - I get what you’re saying about the difference between system infection and a local problem and I will definitely leave a message with the GP and RA nurses tomorrow to get a clearer steer. Thanks again.

[vonniesims]

I had a course of Acyclovir for cold sores , given by dermatology and every time I got another I repeated the course until they went. It took a few repetitions, but it worked. I never stopped any of my other drugs. Good luck

[JulieMBrown in reply to vonniesims]

Thanks very much for your reply. From the range of responses it looks like our GPS / nurses / consultants take different opinions about stopping or continuing medication whilst on antivirals…. I know my consultant disagrees with my GP about when I should or shouldn’t be stopping MTX for example…

[Runrig01]

Have you checked your letters from your clinic visits. All mine in bold text at the end, stipulate gps should stop MTX and biologics gor both Antibiotics and antivirals. Although it’s a localised infection, cold sore virus in immunosuppressed can lead to encephalitis, so I would definitely hold off.

cks.nice.org.uk/topics/herp....

[JulieMBrown in reply to Runrig01]

Hi and thanks for your really helpful reply. The information given in the link is thorough and points to just what you say. We do not get notes at the end of our clinic letters, and sometimes I don’t receive copy letters at all. My GP has very little understanding of my medications, and I rely on the nurse advice line. I’ve left a message with them this morning so hopefully they will get back to me later today.

[Doodlereggie]

hi

I can only speak from recent experience,but I recently had shingles and had to stop my filgotinib while on a weeks course of antivirals,as instructed by my rheumy nurse.i did not have any flare of ra during that time and went back on them after 7 days off.As a footnote,if you read the filgotinib leaflet in the box, this drug can cause activation of the herpes zoster virus,which is shingles and cold sores.this came as a bit of a surprise to me,but is small price to pay,given the relief it gives for the ra!!guess,as always,you have to take the good with the bad!good luck x

[JulieMBrown]

Hi thanks very much for the reply. I was told about the Filgotinib link with the Herpes viruses when the nurse spoke to me about it initially and I agree with you, it’s a fantastic medication - the only one I’ve ever used without having to supplement with painkillers. More than happy to take the rough with the smooth for that!!😀