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Dependent for Years, Enbrel is Next
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
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.
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
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.
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