Combining Enbrel with Other Therapies
from Crystal D.

Ok, here is the deal. I have been on Enbrel for over three months. I started out with two injections per week, then with no signs of improvement we bumped that up to four injections per week. So here is the good news, my P has changed, it is now flat and doesn’t flake (still red like a fire engine though).

However, I still continue to get more spots and they are spreading at an alarming rate. With the use of creams and of course my own light bed I have been working my hardest to keep them at bay.

So here is my question. Have you ever heard of taking Enbrel with other oral medication (like MXT)? I mentioned this to my derm and she said it has been done before. Unfortunately, she is not monitoring my Enbrel, due to location problems. My Family doc is administering the Enbrel, and I know that unless I can come to him with an in-depth plan he will not allow me to combine other meds with this one. Any suggestions would be great.

Thanks, -Crystal D.

*****

Ed’s Response:  Hi Crystal.  I've heard of combining Enbrel with other regimens; however, if Enbrel isn't controlling the spread of your P, I wonder about the utility of combining it with MTX.  The promise of biologics like Enbrel is their ability to replace other systemics considered dangerous in the long run.  MTX and cyclosporine are those "dangerous other systemics."  Most of the combo regimens I've heard about double Enbrel with some non-systemic treatment, usually light therapies (like you're already using) and/or topicals (corticosteroids, Dovonex, Tazorac, etc.).  I've only heard about use of the systemics with Enbrel in an "overlapping" program.  For example, a gradual phase-out of MTX or cyclo after Enbrel has commenced. 

MTX (and cyclo) are powerful immunosuppressive drugs.  Enbrel and the other biologics currently approved for P treatment are also immunosuppressives.  But there’s a big difference.  MTX messes with a wide array of immune system functions — many of which probably don’t have anything to do with P.  The new biologics, on the other hand, target very specific functions inside the immune system and are supposed to leave everything else alone.  Taking an effective dose of MTX might supercede anything the Enbrel is doing.  Having said that, I just burrowed into the “prescribing information” (http://www.enbrel.com) and found a reference that states Enbrel and MTX were used simultaneously by some rheumatoid arthritis patients and the “pharmacokinetics of Enbrel” was “unaltered.”

By the time you read this you've probably been on Enbrel for over four months (more)?  I was on 2 shots a week for 3 months and 4 shots a week for 3 more months.  I gave the drug a total of 6 months before abandoning it.  At the end of six months there was no indication of ANY SORT that Enbrel would work for me.  My P lesions were angry as ever and continuing to grow.  (Evidently they'd not been made aware that Enbrel was supposed to eradicate them!) 

Now it’s been almost seven months since I stopped taking Enbrel.  For six months after that I took cyclosporine, which, as usual, cleared my skin and nails.  Now I’ve been off everything for three weeks and the lesions are trumpeting their return.  Most alarming, however, has been the swift return of the psoriatic arthritis in my right knee.  It snuck up on me virtually over night.  I went to bed with a normal knee, woke up the next day with jr. basketball-sized knee that was hot to the touch.  Cyclo doesn’t do much for PA except keep it in abeyance after something else has managed to suppress it, so it has to have been the Enbrel that thwarted my PA last year. 

Good luck.  Please let us know what you decide to do and how things turn out.  -Ed

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