Methotrexate

[Chris G]

Question......is injectible mtx used because it works better, or only because it's better tolerated by those who have stomach upset, etc? Can you take higher doses of injectible vs. oral? I'm currently on oral, 25mg weekly.

[Hammy8241]

Question......is injectible mtx used because it works better, or only because it's better tolerated by those who have stomach upset, etc? Can you take higher doses of injectible vs. oral? I'm currently on oral, 25mg weekly.

My understanding is that injections get more of the drug into the body and more quickly. It seems to have worked in my case and i was also on 25mg oral prior to the change. It is normal to have a lower dose via injections because of of the better absorbtion. I would expect (but I'm no Dr!) that the injection dosage would be only 20mg.

Not sure how larger a dose you can have via injection but would imagine that rather than go up too far, they would reconsider the drug itself.

[gurinbasra]

I take the injection and was told it absorbs better but I'm on th 25mg/week.

I have a question also to those of you that are on or have taken Rituxan, are you also on Methotrexate, and for those of you who are not, why is that?

[Brooke]

I was put on Methotrexate when first diagnosed but that didn't put Wegs in remission so I took the Methotrexate up to a couple of days prior to getting the Rituxan. Once I started the Rituxan, I was on 20 mg steroids, bactrim, and symbicort. I started to wean off of the steroids about 6 weeks after the first infusion.

[Sangye]

I take the injection and was told it absorbs better but I'm on th 25mg/week.

I have a question also to those of you that are on or have taken Rituxan, are you also on Methotrexate, and for those of you who are not, why is that?
Gurinder, I asked Dr Seo about this at my last visit. He said it's an outdated treatment to use mtx with rtx, but only by about 2 years. He would have done the same thing with patients on rtx 2 years ago. Apparently some RA research seemed to show that mtx prolonged the effectiveness of rtx, but that has been disproven with further study. He says it doesn't do anything to keep a Weggie on mtx while using rtx but it's "harmless."

[gurinbasra]

Sangye, thanks for your response, I'm printing it out and taking it to my Rheumy appointment tomorrow. I am his first (Calgary's first) Rituxan Wegener's patient and I think the only hold back on Rituxan is that you're asking your patient in Alberta to cough up $10,000 so perhaps he's not aware that you can take it Rtx without the Mtx, but I am going to push for this as that'll be one more medication off my list - maybe the rest of my hair will start growing back!

[drz]

Sangye, thanks for your response, I'm printing it out and taking it to my Rheumy appointment tomorrow. I am his first (Calgary's first) Rituxan Wegener's patient and I think the only hold back on Rituxan is that you're asking your patient in Alberta to cough up $10,000 so perhaps he's not aware that you can take it Rtx without the Mtx, but I am going to push for this as that'll be one more medication off my list - maybe the rest of my hair will start growing back!

That is asking quite a bit, $10,000 whether that be Canadian, Hong Kong, or USA $. Is that true for everyone in Canada getting RTX?
Are you expected to pay for your meds generally?

[Sangye]

Rtx costs $10,000 per infusion in the US also. So one round (either 2 or 4 infusions) costs $20,000-$40,000.

[pberggren1]

I know that my health care here would pay for it.

[drz]

I know that my health care here would pay for it. I guess that is my question. Are your meds or drugs generally covered by your Canadian health plans?

[gurinbasra]

Canada has a national health system which is free but based on drugs that are Canadian approved and this varies from Province to Province. Rituxan is not an approved health care drug in Alberta because it's new (according to them) so if you have health insurance via work that may or may not cover for it. Most of the Eastern Provinces have this drug covered - I know, I know, it's crazy why we're not all allowed the same rights. I was lucky that my insurance co. covered 100% but my husband's co does not at all. This is why perhaps some Dr's have been hesitant in giving Rituxan because some people don't have insurance or just don't have $10,000 sitting around! Another not fair in life moment! Generally, all my drugs except this one is covered by the health system. It is definitely a shock to see a $10,000 bill ($5,000 for each infusion), but a relief that the amount due was $0. Don't worry, I"m working on getting Rituxan approved in Alberta - as soon as I get the energy to start being a b*&^*!

[pberggren1]

Because of my low income I have 96% coverage on most of the meds I pick up from the pharmacy except ctx and Alendronate right now. In Saskatchewan the rtx would be fully covered.