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For Him Enbrel Reduces Skin P Without Entirely Eliminating It 
from Kurt

Ed:  Thought I'd give you an update on my Enbrel usage.  I had written earlier about my poor results on Soriatane and the excellence of Enbrel.

When I started Enbrel I initially was taking two 25mg shots per week.  I achieved great results but I stopped just short of clearing completely.  My arthritis symptoms disappeared completely — so much so I had a hard time remembering what they felt like.  After several months my psoriasis crept back slightly on one leg.  Not anything like pre-Enbrel, however.

Note: Pre-Enbrel coverage 20-30% ; during Enbrel 1-5%.

With my P creeping back my derm ok'd a higher (100mg/wk) dosage (thanks Ed, I became aware of this from one of your e-mails).  This brought me closer to clearing but not quite as close as before.  Is my immune system adapting...hmm?  After three months of this I stabilized just shy of clearing.  At this point my Derm said that it is recommended practice to reduce dosage back down to 50mg.  Thinking I had hit a plateau that wouldn't change much based on dosage I agreed and we decided to reduce the dosage.  Soon afterwards my P began creeping back.  Three months later my Derm and I met and we agreed for me to go back to 100mg per week.  Again my P got better and stabilized just short of clearing.  This is where I am to this day.

Overall Enbrel experience:  Great clearing, arthritis symptoms disappeared, one temporary weeklong thrombosis near an injection site that may or may not be related to the treatment (I think yes, the official response was no).

And compared to having P, giving myself injections is not a big deal.

Take Care, -Kurt

*****

Ed’s Response:  I love good news, Kurt.  Being on the opposite side of the equation from you right now, your side looks like greener pastures!  I’m trying Raptiva, which may help my skin but isn’t likely to do anything for my P-arthritis, so it’s flaring BIG time.  You, on the other hand, are sustaining some problems with the skin while on Enbrel but have forgotten what P-arthritis feels like.  The last time I was able to claim I had forgotten what P-arthritis feels like was the last time I was on methotrexate.  And, frankly, I don’t know if I’ll ever be there again.

Your question about “Is my immune system adapting?” is perhaps the most important question being asked about all the biologics for P right now.  And for good reason. 

All of us who live with this disease have come to know it as a restless beast that eventually overcomes everything we do to try to contain it.  Now, along comes this new type of drug — made from natural proteins, too delicate to survive administration in pill form, targeted to very narrow immune system actions — and at least some of the manufacturers are saying, Take it forever!  Enjoy clearance forever!  Who can blame us for being somewhat cynical?  Yet last month Raptiva announced the end of a 3 year Raptiva user group study (small number of subjects) that suggests many sustained their clearance and experienced no adverse side effects.  Can it be true?

At this time, about all we can say is Stay Tuned.  And Kurt, you stay in touch, too.  -Ed

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