Methotrexate Dependent for Years, Enbrel is Next
from Lori

I've taken Methotrexate (MTX) for about 16 years now, with small breaks now and then but mostly at least 7.5 mg a week up to 25 mg, either IM or oral.  It's been pretty hard on me the last couple of years, though my liver is holding out.  And it's always hard for me to tell where the MTX side effects begin and the P and PA symptoms meet. 

Right now is just a horrible time for me, with my skin, especially the last 2 weeks.  It's usually a bad time of year, but the MTX is not doing such a hot job despite my recent increase in dosage.  My biggest problem right now is pain in my neck and back from the PA which never seems to leave because of the permanent damage. I am suffering from extreme fatigue, in part, because the pain wakes me up.  I'm also depressed which has been diagnosed as reactive to the psoriasis and it's disabling effects.  Hopefully, soon I will get put on Enbrel in a few weeks once the new Rheum can convince my insurance it's a good bet. 

For the most part I have heard good things about Enbrel.  I am trying to hold to that thought and to the thought that if it doesn't work it's possible one of the other biologics will.  I cannot stop taking MTX, or I will flair too severely, which should be a testament in itself to it's effectiveness. All in all, MTX has been a life saver for me and I am extremely grateful for it's effectiveness throughout the years.  –Lori

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Ed’s Response:  Thanks for writing, Lori.  A few correspondents here have been on MTX for over a decade and I guess the way to manage that — and avoid the accumulated toxicity of the drug — is to vary the dosage, like you’ve done.  7.5 mgs a week is, as you know, an extremely mild dose.  It wouldn’t be enough to effect me unless, maybe, I stepped down to it after many months of a more potent dose.  25 mgs, on the other hand, is about the max most derms want to prescribe.  On two occasions I talked my derm into upping mine to 30 for a month or so, but 25 mgs was always my “normal” dose. 

I’m curious:  How many liver biopsies have you had in 16 years?  Did you refrain from using any alcohol while you were on MTX?

Your chances of responding well to Enbrel are as good as anybody else’s, Lori.  And I hope you are on the right side of the line: the side where Enbrel works. 

I’ll always wonder if my own non-response to Enbrel had anything to do with the fact that I stopped everything else cold turkey.  In early 2003 (when I started my six months on Enbrel) no one was even suggesting that you continue a systemic regimen (MTX, Cyclosporine, Soriatane) while commencing Enbrel.  Since then, of course, it’s become common.  And just about everyone who’s written to FlakeHQ while on a combined Enbrel-something-else regimen has reported good results. 

MTX never completely cleared me (cyclosporine always does).  It would have been nice to learn that a reduced dose of MTX, combined with Enbrel, might have done the trick.  Since I didn’t have the opportunity to try, I’m going to experience it through you, vicariously.

So please keep the reports coming, Lori!  -Ed

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