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Cyclosporine and Enbrel
Prescribed at the Same Time?
Hi Ed. I have currently just began Enbrel injections (50mg) once a week 5 weeks ago and am still orally taking 400 mg of cyclosporine (Neoral) daily. As your site seems to be the most "switched on" to Psoriasis that I have found, I was hoping you could point me to some "substantial" information regarding the interactions of Neoral and Enbrel as I can not seem to find a great deal of information regarding these two drugs interacting together, I hope to be able to contribute more writings in the future to your pages as the mood strikes me to write, thank you for your time. Kind Regards, -Neil.P.F.
Ed's Response: There probably is NOT an overt reaction from simultaneous use of cyclo and Enbrel. I suggest this because the U.S. Food and Drug Administration (FDA) is pretty demanding about study and disclosure of drugs used to treat the same disease. However, given that cyclosporine is a powerful immunosuppressant that attacks inflammation very broadly, and that Enbrel (etanercept) is ALSO an immunosuppressant, though a very narrow-acting one, combining the two would logically pose more risk of TOO MUCH immune system suppression.
Which is why I can’t help but wonder if your doc’s long-term plan is to phase you off of the cyclo. Many likely candidates for successful Enbrel therapy (including myself) bailed out when more than three months went by with no positive response to treatment. Enbrel, and most other biologics, are dosed in fixed amounts, independent of other factors such as body weight. Cyclo, on the other hand, has a wide dosing range that starts at the maximum suggested daily dose based on body weight, but which can be smaller to achieve a “safest effective dose” for a given patient. Cyclo also tends to act faster than biologics for many people. The only reason I can imagine your doc prescribing simultaneous uses of cyclo and Enbrel is to accomplish quick positive results from the cyclo while your immune system is “gearing up” to let the Enbrel work ... followed by an eventual phase-out of the cyclo and maintenance using Enbrel for as long as it remains effective.
While you are using both cyclo and Enbrel you need to be perpetually alert to signs of serious infection. Any elevated temperature is one good indicator that you need to be tested, visible inflammation (reddening and/or soreness that you can see) is another. Also, I hope your doctor has suggested a strategy for combating a suspected infection; i.e., any actions for you to take at first indication of an infection. I would assume the first “step” would be to stop using one or the other – or both – of these two drugs at least until lab tests can determine what ails you.
Please let me know how you fare on the combined therapy, and if I’m right or wrong about the Dr’s intent to phase you out of the cyclo. While this particular combination of drugs does not seem to be commonly prescribed in the U.S. right now, Drs here have great freedom in “bending” the status quo. Having your experience on the record here is very valuable now and in the future.
And ... send more poetry, too! -Ed
Neil's Response: Thanks for writing back to me so promptly, you are correct with your thoughts of my Dermo tapering off the Cyclo, I have had a bit of a roller coaster with flares etc, I have been on cyclo for almost 18 months now and really hope my body gears up to Enbrel shortly so I may hopefully start to back off on the cyclo, I have tried to taper off the cyclo several times only to find I flare very rapidly and each flare seems worse than the previous, so the next logical choice for my Dermo I suppose was Enbrel, to which I have seen no positive effects as yet, but I will keep you posted.
Thanks again. Kind Regards, -Neil.P.F.