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Awaiting Enbrel After Methotrexate Disaster
from Ben K.

Backstory:  Cyclosporine or Enbrel?

Hi Ed:  Glad to see you back!

I have now talked to my derm and GP (general practitioner) and have ascertained that I may be able to circumvent the problems with using Enbrel but have to wait for an NHS referral.  My GP is happy for me to remain under the treatment of my Derm (who I like) and to "copy" his scripts onto an NHS script so that I can get the treatment for much less.  Unfortunately, though, he wants to wait for my liver enzymes to return to some form of normality.  This seems to be a slow process.  My Gamma GT and AST are back to normal, but my ALT is still about 3 times normal.

I'm hoping that my liver function tests will continue to improve otherwise I will need a biopsy to see what is going on and that is something that I want to avoid if possible — the liver professor I saw wanted to do it "intra-jugular" under local.

I think that my severe reaction to the MTX [methotrexate] has put both me and my Derm off the idea of using Cyclo [cyclosporin {UK}, cyclosporine {US}] as obviously any kidney related side-effects are not so easy to reverse.  Equally, my derm was also reluctant to use Raptiva for the same reasons although that would have been his preferred first biologic to try.

I was offered a "Phase 3" trial of a new biologic, but unfortunately had to make a decision within 24 hours and given the state of my liver at the time was not ready to take the plunge.

So at the moment it looks as if I will wait and see if my liver function tests improve and then try the Enbrel route.

I also wanted to ask you to pass on my thanks to Kelly Z. for her response to my email.  It may seem a very strange question, but please ask her if she was the young lady who asked me one morning in Java Java on Dearborn and Monroe whether I had Psoriasis and whether I had tried Enbrel?

Also to Kat (my fellow Brit) my scalp P hasn't been too bad in recent years (although that's where it all originally started 20 years ago!).  For a long time I used Nizoral shampoo which can be bought over the counter in any Chemist which seemed to work quite well for me.  It never cleared it, but did keep it under reasonable control.  Also whilst in Chicago I was prescribed Loprox shampoo which seems to also work quite well (I'm not sure whether or not it is available here as I brought back quite a supply with me!).

Warm regards, -Ben K.

*****

Ed’s Response:  Good to hear from you Ben — and especially to hear that you’ve got a treatment PLAN (at least) for replacing the methotrexate that worked so BADLY for you (see Backstory reference, above). 

I hope you’ll respond well to Enbrel.  At the moment, it’s the most popular biologic for P in the U.S. 

Loprox shampoo has me scratching my head.  Its active ingredient is ciclopirox, which is a hydroxypyridone antifungal agent.  It’s most prescribed for seborrheic dermatitis.  Lots of flakers find anti-fungal agents improve their P symptoms, but I can’t figure out why.  -Ed

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