Weening off methotrexate & Sulfasalazine

Birdingben

Hello!

I've recently had a THR and had to stop taking my biologics injections a couple of weeks before the op. I only started the Yuflyma (adalimumab) in April so hadn't really started to feel the benefit of it before I had to pause taking it.
I was advised to continue the MTX & Sulfasalazine as normal ie 20mg each week of the former & 2g each day of the latter .
As I've been on MTX for over a year & Sulfasalazine for 10 months I'm keen to start coming off them & let the biologics take over.

Has anyone had a similar experience & instructed as to a sensible reduction rate? I've been told to reduce at 2.5mg every 3 months for MTX which will take 2 years to finally come off them if that rate is maintained!

Thanks for reading.

Arciere

Hi @Birdingben

I had a terrible 2023 much of which I attribute to the chopping and changing of DMARDs

Whilst this might not be helpful, I’ll just say please do agree a plan with a Medic to help you transfer. Essentially I came off MTX quickly and then started Sulfasalazine. I then came off that abruptly and had a long gap between starting the biologic, which really meant I was quite unwell. So please don’t do anything without advice….is my advice.

Birdingben

Hi @Arciere

Thanks for your reply.

Absolutely, I won't be self-medicating without expert advice. Sorry to hear about your experience & hope you're now getting the benefit of the biologics.

jamieA

Hi @Birdingben

I have psoriatic arthritis and take 3gms sulfasalazine, 10mgs MTX and Amgevita - another make of adalimumab. My rheumatologist told me the 3 drugs work synergistically so the benefit of the 3 is greater than each individually. I was keen to reduce my drug intake and in early 2023 my rheumatologist reluctantly agreed to reduce my sulfasalazine from 3gms to 2 gms. I then had a flare and needed a steroid injection. I know we are all different so how it affected me may not be the norm but I'd make sure that you agree a course of action with your rheumatologist beforehand in the event you do have an adverse reaction.

Birdingben

Hi @jamieA

Many thanks for your reply.

I certainly won't go against advice from the experts & heed what you say about, like me, wanting to reduce your drug intake. After several years of additionally being on oral steroids & now a slow reduction programme, I didn't want to prolong the risk of liver damage by continuing with MTX & sulfasalazine any longer than I needed to.

Patience is a virtue (which I struggle with!)

I hope your regime of meds works effectively for you 🤞