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Her Cancer Fear on Enbrel
from Elena M.

Hello Ed! My name is Elena and I am from Nottinghamshire.

I have had RA [rheumatoid arthritis] for now 7 years — as long as I have had my son. No traditional medication helped me. I was a bad case, but Enbrel cleared my arthritis in weeks! I enjoyed a pain-free life for 4 years with NO SIDE EFFECTS whatsoever. Got a good job, got qualified, but after I found out about Enbrel-related cancers, I got off it. Since then I’ve experienced pure misery. Commuting to work, walking ...  doing anything is an agony. I am now so depressed, that I decided to go back on Enbrel. Simply can't go on living with so much pain.

I wondered about your experience of re-starting Enbrel after your cancer treatment. Will be nice to have your thoughts on this.

Many thanks.  -Elena


Ed’s Response: With regard to my Enbrel (etanercept) experience, most importantly I used it for only a few months after my testicular cancer, but never achieved your good results. In late 2003, when I stopped using Enbrel, I started a course of cyclosporine (a non-biologic systemic drug used for psoriasis, among other things) and used it with success until I started another biologic in 2004. I don’t believe my unsatisfactory results from Enbrel were entirely the drug’s failure in my case. I think I was under-dosed initially. I should have taken double the recommended dosage when it became obvious that the recommended dose would not clear my skin, at least not at the onset. 

In 2004 I used Raptiva (efalizumab) with great success for my skin but no help whatsoever to my arthritis. In fact, it was Raptiva’s inability to help my arthritis that led me to Humira (adalimumab) in 2005. I’ve been using Humira with wonderful results — both for my skin AND my arthritis — since 2005.

All of these drugs are ‘biologics’ derived from living tissue and requiring injection rather than digestion to work (shots rather than pills). All of them come with some sort of cancer warning (as well as warnings about increased risks of infection). Raptiva was taken off the market in the U.S. in 2008 because it was linked to 3 deaths from PML, a brain infection. So far, Enbrel remains the most popular biologic for psoriasis and psoriatic arthritis in the U.S., though I think Humira is gaining popularity. And we have a couple of new biologics on the market, one — Stelara (ustekinumab) — that require less frequent dosage, every 12 weeks after a start-up period. I suspect lots of people will be trying out Stelara even if they’ve done well on Enbrel.

I don’t know which of these (other than Enbrel) are available in the U.K., but you might want to ask your rheumy about them.

I do believe that if I started using Enbrel again, but with a double dose and no long interruption due to other illnesses, I might find my results much better.

And as far as the “cancer scare” goes ... Being older, with diabetes and heart disease as well as psoriasis and psoriatic arthritis, adding a remote possibility of drug-induced cancer to my pantheon of potential complaints seems a less heinous option if the other side of the coin might be a few more years with clearer skin and no joint pain.

Good luck to you.  –Ed

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