Combining helminthic therapy with drug treatments
Immunosuppressant drugs are fully compatible with helminthic therapy[edit | edit source]
No incompatibility issues have been reported as a result of combining NA, TTO or TSO with any immunosuppressive medication, such as the following examples mentioned by helminth self-treaters.
Cyclosporin; synthetic corticosteroids including prednisone and its active metabolite, prednisolone; the thiopurines, azathioprine and mercaptopurine/6-MP (purinethol); the TNF inhibitors, infliximab (Remicade), adalimumab (Humira), certolizumab pegol (Cimzia) and golimumab (Simponi); humanized antibody drugs, e.g., omalizumab (Xolair); humanized monoclonal antibody drugs such as natalizumab (Tysabri); and recombinant fusion protein drugs such as etanercept (Enbrel).
No need to terminate therapeutic helminths while taking immunosuppressants[edit | edit source]
The detail sheet for some immunosuppressant drugs - for example dupilumab (Dupixent) and tezepelumab (Tezspire) - may advise that helminth infections should be treated before commencing use of the drug. This advice is to prevent immunosuppression by the drug from supporting the proliferation of pathogenic helminths, but this is not an issue for users of NA, TTO or TSO because these species cannot proliferate within a host. (For example, see, Can hookworms multiply within a host?.) However, it may not be advisable for anyone to take HDCs who is immunocompromised as a result of treatment with major immune-suppressive drugs, or due to HIV/AIDS or a genetic condition. [1]
Immunosuppressant drugs can reduce initial helminth side effects[edit | edit source]
It can actually be an advantage to be taking an immunosuppressive drug in the early stages of helminthic therapy using NA, TTO or TSO because the drugs reduce, and often completely prevent, the transient side effects sometimes caused by the introduction of helminths, especially NA.
People who are already taking a daily dose of prednisone when they begin helminthic therapy experience little or no side effects after inoculation, and those who have used this drug on a short-term basis specifically to reduce side effects have found that 5 or 10 mg per day is usually sufficient for this purpose.
If prednisone is used specifically to relieve side effects, the prescribing doctor will determine a taper to wean their patient off the drug and, if the symptoms return, they may be willing to defer the taper.
Immunosuppressant drugs can help helminths become established[edit | edit source]
Immunosuppressive drugs can help human helminths become established by reducing intestinal inflammation, so anyone who is already on one of these drugs should resist the temptation to stop taking them too soon after introducing NA or TTO. As the majority of those who respond to this therapy don’t see significant or consistent benefits until at least 3 months after their first inoculation, it would arguably be unwise to stop taking an immunosuppressant drug before this. In fact, many users have found it best to continue with the drug treatment beyond this point because some people only start to improve between 6 and 9 months, some only after 9 months, and a few not until between 18 and 24 months.
One individual with IBD-related arthritis found that reducing prednisone too soon caused her joints to ache and stiffen, so she continued to take azathioprine (Imuran) on its own after stopping prednisone, and this provided an intermediate step which allowed her to wean herself off drugs altogether, a process that took between 8 months and a year. [5]
Immunosuppressant drugs can support helminthic therapy[edit | edit source]
Even helminth hosts who see early benefits can continue to experience periodic exacerbations or flares of their disease for up to 18 months, and a few may need to continue to take medication alongside helminthic therapy in the longterm.
Another self-treater who has kept his ulcerative colitis in remission for many years by combining TTO and NA, also takes 6.75g per day of Balsalazide (Colazal). He says that he probably doesn’t need the drug now, but that it’s cheap and has no side effects so he continues to take it. (Details from private communication.)
In view of this wide variation in experience, each individual must decide, in consultation with their physician, how long into their therapy to continue with an immunosuppressive drug before beginning, very slowly, to taper the dose. However, one supplier of human helminths (NA and TT) has been very specific about this and advised waiting until at least five months have elapsed after achieving a substantial improvement in symptoms.
This is particularly important for subjects with Crohn’s disease, or one of the other intestinal diseases, because they tend to have a vigorous immune response to helminths, so suddenly stopping a drug that has been keeping this response in check may result in a flare and, potentially, a loss of worms in the case of NA or TTO.
Some drugs can harm therapeutic helminths[edit | edit source]
A few drugs are harmful to helminths, and those that can adversely affect NA and TT are listed in the Human Helminth Care Manual. These drugs include some oral and injected antibiotics, the effects of which can be such that there may be little point in using NA, or possibly TT, if there is a need to take antibiotics regularly, or on a longterm basis. Those drugs that are incompatible with TSO are listed here: Caring for TSO, and those that are best avoided by users of HDC are shown here: Caring for HDC.