Methoraxate alternative?

[jaycee444]

What alternatives are there to Methotrexate in the Uk? My Gp has previously mentioned Methotrexate as an aid to reducing Prednisolone . I havent had Rheumatology appointment in a while - my last one was cancelled due to staff shortage - but I do not want to take Methotrexate because of reported bad side effects. I know any drug can have side effects but I already have Ulcerative Colitis and I believe it is not recommended so if I am offered I will refuse. Are there any other alternatives in the UK and if so can they be taken by injection to save the gut? I would like some time to research anything else on offer. I am currently on 6.5mg (double at moment as following sick day rules (Covid) but struggling to get any lower so I am sure at my next appointment the question will be raised.

[PMRpro Ambassador]

If you have u/c why is the GP so desperate to reduce your pred? I have no doubt it is helping to control any symptoms of that as well. Since you are already down to 6.5mg I think your GP needs some education - they have this kneejerk response to pred, all patients must get off it asap ... Look at the big picture.

crohnsandcolitis.org.uk/inf...

Azathioprine is used in colitis too - and is occasionally used as a steroid sparer for PMR:

crohnsandcolitis.org.uk/inf...

This

crohnsandcolitis.org.uk/inf...

summarises everything for the GI side - and really there isn't that much overlap. PMR is mostly due to the IL-6 cytokine but that isn't a player in colitis. Leflunomide is an option for PMR - but not for colitis and it can cause colits, I'd steer clear of that!

But if you are doing well on 6-7mg pred - your GP is havering. Luckily HE can't mess about with any of the add-ons drugs, they are up to your rheumy, Who I hope is better informed. It might be worth trying AZA or MTX - but why?

[jaycee444 in reply to PMRpro]

Thank you for that info.. The Prednisolone certainly has a beneficial effect for my ulcerative colitis. I know any steroid sparers will come from my rheumatologist. Problem is I see someone different at each appointment and they all have differing approaches. I am sure they dont see the bigger picture as far as other conditions are concerned. They are the Rheumatology Department and I dont think they take anything else into account. I am certainly at my next appointment (which is nearly 10 months late now) going to argue my case for a really slow taper) . It’s very difficult when you are told to reduce quicker than your body is happy with. … They must think that we actually like taking steroids. I will be really happy to be free of them but not at the expense of all the pain I would be in without them.

[PMRpro Ambassador in reply to jaycee444]

Since you have a dual reason for using them - they need to take that into account and any rheumatologist worth their salt should be wary to adding in something that might or might not work to reduce the pred for the PMR when you have a complex history. There are no guarantees that any of those things will contribute to managing the PMR either, you have to try them for some time to find out if you can tolerate them and longer to see if they work. I would simply say NO.

[yorkieme]

This may be of little help but with regard to alternatives I started on Methotrexate tablets then moved to injections,couldn't cope with the side effects so moved to Leflunomide,then Azacitridine and now settled on Tacrolimus,(Adoport,) Each are supposed to have the same effect but the reason that I changed to each one was the adverse side effects.

You are certainly wise to do your research and ask the right questions as each of the above may affect you in a different way. Good luck.

[PMRpro Ambassador in reply to yorkieme]

"Each are supposed to have the same effect"

in the sense of immunosuppression possibly. But the latter 2 have never been looked at in PMR. Did they have any effect?

[yorkieme in reply to PMRpro]

I think the idea behind using them in my case is that the consultant and rheumatologist are in their words treating me for a systemic inflammatory disease, PMR with complications.

I'm not sufficiently knowledgeable on the subject to say they work as I have yet to receive a response to my question of what are they for ? The one reply was that they help me reduce my steroid dose ...... if so then they work as I stopped Pred' in October last year. Early days I know.