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Biologic To Try?
Hello Ed and
thank you so much for your wonderful web site.
I have had
severe psoriasis for more than 20 years and psoriatic arthritis for
under 10. I have used PUVA
phototherapy (successfully but did not want to
continue because of the dangers) and MTX (also helpful but had to stop
because of liver complications). I
might now have the opportunity to try Raptiva
or Amevive and it seems that I have the option to choose one or the other.
But my readings have been somewhat confusing.
If there is no other information, my quick readings up to now seem to favor Raptiva:
I understand of
course that different people respond differently to medications, but on
paper these three points make sense to me.
Are you aware of any
additional PA-specific information? Enbrel
seems to be superior (and
approved) in that respect, but I do not have that option.
Again, thanks a lot for the great service you are providing to a community in need of help. -Alex X.
Response: Thanks for writing,
Alex. It may really be
unfortunate that neither Enbrel or Remicade are on your list of possible
biologics, since both of these are supposed to help PA.
During the six months I was using Enbrel, I believe it helped my
PA, but it did nothing for skin.
But from what
I'm hearing about the biologics at large, regardless of which one you try
first, I would counsel you to be prepared to try more than one.
I always suggest people accept their doctor's advice if it is
satisfactorily explained to them; however, when it comes to new medicine
regimens, I suggest you and the administering doctor agree to goals (in
terms of improvement) a time line (how long to keep trying) and exceptions
(things that might cause you to stop early).
Then, if the first thing you try doesn't meet your goals, be
prepared to try another.
Genentech’s prescribing information about Raptiva (go
here) and mostly concur
with your “bullets.” The
Genentech literature says your doctor “may monitor platelet counts”
during your course of Raptiva, which would involve blood tests.
I would imagine that if I were in your shoes (about to try Raptiva)
my derm would most definitely call me in monthly for blood workups
(because of my recent history of severely depressed immune system
function). In general, though
the Genentech mention of this is the mildest of any of the biologics
I’ve read about.
Please drop us a line and let us know what you end up trying and how it works out. A “mid-stream” report would be most welcome. -Ed