Can you take more than one DMD?

[karryon55]

This has been bugging me a bit & was hoping some of you could advise me on what options there are. Some of you may know I was recently dx'd with MS over 3 weeks ago. I have a few autoimmune diseases (RA is one) so have spent a lifetime trialling DMD's & didn't have great success until Rituximab came along 5.8 yrs ago.

I was always on Rituximab & Methotrexate injections up until 2.5 years ago when the doctors ceased the Methotrexate due to ongoing Septic neutropenia & on a couple of occasions my Neutrophils would just drop to zero. It was thought the combination of both drugs was putting me at risk & I wasn't going to argue after spending weeks being reverse barrier nursed on multiple occasions.

Unfortunately nobody is certain what causes the neutropenia in me for sure & I have never had a bone marrow biopsy done as I was too sick at the time. It may be nothing to do with either Rituximab or Methotrexate & it could be just "my body" has difficulties especially when I have infections or illness going on.

I have noticed that my MS has appeared to be worse since the methotrexate was ceased. Don't quote me on that it's just I feel I am slowly going down hill. I know I cannot go back on Methotrexate as it was causing other blood disorders in me as well. I need the Rituximab for my arthritis which is severe.

Can you take one of the other DMD's for MS as well as Rituximab? I have had elevated liver functions for 2 years straight now & not just slightly. Has anybody heard of more than one DMD being used? Nobody has mentioned treatment for me when they hear I can't come off Rituximab it subject closed.

Thanks....Karry.

[karryon55]

Thanks Sarah. I am hoping my rheumatologist & neurologist will nut it out together in the long run. It would be nice if they could liaise with each other in regards to my treatment.

Take Care

Karry.

[SarahL2491]

I know that if you are on Tysabri, they do not want you on another DMD because it increases your chances of PML dramatically.  Other than that, I would discuss it with your neurologist AND your rheumatologist.

[karryon55]

Thanks for that DV. It is promising when you read that. It's a shame that Rituximab is not available to everyone with MS but hopefully it will be in the near future.

I believe they made a copy drug targeting CD20/B lymphocytes that was removed due to deaths of people during trials & the patent ran out for Rituximab some time ago. I think something will have to be done about the situation.

Take Care

Karry.

[doublevision1]

Hi, this might be of interest to you:
http://www.ncbi.nlm.nih.gov/pubmed/23139702

[karryon55]

I am going to discuss it with my Rheumatologist because it is more common in that environment to be on more than one DMD. Most of my life I've been on 2 DMD's at once but it's known certain ones you never combine. I think my Neuro is watching & waiting with me & I see him in February unless I need to see him earlier.

In theory somebody with RA takes the same dosage of Rituximab as someone with MS but in RA it is to be taken with Methotrexate or another DMD if not tolerant to MTX. I can have the Rituximab earlier at 16 weeks instead of 26 weeks but they wouldn't approve this regularly.

I know it sounds odd to discuss this with my Rheumy rather than Neuro but most of the "off label" drugs used for MS have been used for much longer in Rheumatology & I have been on them before with him anyway. My Neuro did mention some centre that is doing research into people with multiple autoimmune diseases & that they would find me interesting. I will discuss that with him in February.

I don't think any of my doctors would want me to be on anything else due to my history. I may decide to not go on anything else but would like to know what my options are.

Thanks immisceo & Laura for your help.

[Lulu54]

That's a a fair question  and from what I know they do not do one over the other. I have a good friend with RA and MS and she is on rituximab as both her RA and MS drug.  She had been on a DMD before then.

The studies on the trials combining two DMDs together were of great interest to the researchers, but I believe they have recently announce it didn't improve the outcome.  

The mystery to me, though, about all these MS studies, is how they can really get true results over a period of a year or two....  I always think it would take a long time to really know what effect something has had.  

What do your doctors say about this question? I would love to know the official answer. :-)

[immisceo]

Someone may well come along with better information than myself, but I think any such use would be either deemed 'off-label' or done as part of a clinical trial/academic study. I know some of the bigger companies have done studies combining at least two of their own drugs with seemingly positive results, but I don't think any DMD regimens are officially sacnctioned for the public at large.

I know that we do have members on or soon to be on Rituximab soon, so hopefully they'll chime in with advice they're getting from their doctors and the taper requirements/reasons they've been given for any transitions between treatments.