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Enbrel: To Do or Not To Do
From Marty H.

Ed:  I've had psoriasis for 22 years, I am 40.  I've exhausted all of the topical steroids, had some success with Soriatane, and am now facing the biggest decision of all.  I have psoriasis severely in my scalp, eyebrows, eyelids, forehead, cheeks, neck, ears, elbows, knees, and small patches on my chest, back and private areas.

My dermatologist in McAllen, TX, told me he had exhausted all topical treatments and suggested I would need to take more powerful drugs.  I have since moved to Houston, and am in the process of gaining approval to take Enbrel for my psoriasis. 

I'm not certain whether I have P-arthritis or not.  I have daily pain in the bottom on my left foot, which makes walking difficult.  I've had X-rays taken and I don't have bone spurs. 

Ok, the question.  Should I take Enbrel or not? 

The dermatologist downplayed the side effects.  They seemed very eager to put me on Enbrel.  My brother-in-law has his doctorate in pharmacy, and he told me he would take it if he had psoriasis as severely as me.  Am I being vain?  I would love to be less self-conscious, but how great a risk is cancer?

Thanks, -Marty H.

*****

Ed’s Response:  I'm told and still believe the risk of cancer from taking Enbrel is small.  Consider your family history with cancer.  If the proclivity for cancer appears to be in your genes, the risks of getting a cancer as a side effect of Enbrel may be greater than average.  Note the cancer (actually, a family of cancers) most associated with Enbrel — and these less than statistically significant — are lymphomas.  I've still found no Dr. willing to suggest an association between my Enbrel therapy and my testicular seminoma. 

Be advised Enbrel is most successful with PA.  I've been on the drug for six months now — three of those at twice the standard dosage (100 mgs a week versus 50) and have experienced NO improvement of my lesions.  My PA, on the other hand, has lately shown considerable improvement.  Amevive might be a better biologic choice for my skin and may be my next attempt.  Ask your derm why he's favoring Enbrel over Amevive in your case.  He probably has a good answer.  If a rheumy can look at your foot and confirm PA, your foot pain is likely to improve on Enbrel. 

Let us know what you decide.  -Ed

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