Interference from Enbrel

If anyone talks to Hepresearcher and has the oppotunity, ask him if injecting Enbrel concommitant to Pegintron and Riba would interfere negatively with Peg or Riba in terms of efficacy.  H's doc don't think so and frankly scratch their heads and say, it might even be helping and be the reason why he had such a low starting viral load.  I'm beginning to wonder...

[jmjm530]

I investigated Enbrel early-on in treatment when it was suggested by my dermatologist for psoriasis. Enbrel was suggested because it was one of the few systemics for psoriasis that was not liver toxic. My hep doctor had no problem with Enbrel either (I believe a couple of his patients were on it) but I ended up going in another direction with UVB Narrow-band and X-trac Laser.

As stated, Enbrel apparently does not tax the liver and in fact at one time they were trialing Enbrel with SOC to see if it could actually enhance SVR rates. Not sure what happened with the follow-up on those trials.

Later in treatment I spoke to a very well-versed hepatologist who basically said, don't use Enbrel if it's not needed, but absolutely use Enbrel if it will make a difference keeping me on treatment.

His reasoning was that Enbrel hadn't been studied enough with Peg and Riba, so
why take a chance adding another immunosuppressive (Enbrel) to the mix since I was doing so well with treatment at that point. ((I was RVR).

If my psoriasis had gotten any worse, I would have had no problem using Enbrel
and looking back I wonder if using Enbrel would have spared me a lot of misery with my skin issues. Also, had I not been RVR, I might have added it to the mix to see if it might help kill two birds with one stone (the virus and the psoriasis).

All the best,

-- Jim

[motheroffour]

Thanks for the comment.  I'm always going to wonder.  He just went off it again, so he's been on and off before and during treatment.  It does just sort of muck the waters in terms of what is doing what to what.  That said, my H doesn't have much options for his P unfortunately. Thank heavens they didn't put him on methotrexate or one of the other drugs that is toxic because nobody knew that his liver was in this bad of shape nobody, it could have put him into end stage liver disease. I really think deep inside he might have begun to blame the Hep for the P. But I think he's going to have the P forever, the Hep hopefully somehow, someday he can get rid of.  Enbrel is amazing, he flared this winter and within a month of Enbrel - virtually gone except for little patches here and there on elbows, back and legs.

[jmjm530]

I guess what I was trying to say in a long winded way was that since your husband is already on Enbrel, I really wouldn't worry about it, especially if it's helping his skin issues. In fact, the Enbrel/SOC mix may actually be helping his chances of SVR as his doctor suggests. No one really knows.

All the best,

-- Jim

[friole]

Yes, i see where he is coming from .  But is it a slow decline or a quasispecies that is particularly immune.  I didn't decide until close to 48 to extend -- in fact my backwater GI said NO at week 36.  I went in armed for bear at 48 but he said yes. I just wish now I had gone longer.  With replication rates of 2,000,000 a day, I guess those virons don't have to hid in cirrhotic liver tissue. I can't say I understand it but I do know positive thinking is not enough.  Sometimes it pays to go across state to the experts.

All the best,
frijole

[friole]

I was reading your post on another thread -- that your H didn't clear until week 30 and we is just doing 48 but he is stage 4.  Are his sides too unbearalbe to continue?  Does he have a backup plan?  What about maintenance dosing.  Maybe this has already been discussed on another thread - I don't read as much lately.  I hope he is not going to give up
frijole

[motheroffour]

Nope, he's pretty sure he's stopping at 48.  He's undetected right now but that slow decline from 75 down to undetected was a long and slow one. They were hiding probably in whatever portion of his liver is "probable cirrohsis". His doc is shall we say "backwater"  so  if he doesn't SVR (his odds are virtually nil) then he's thinking he needs one of  "them thar new fangled additives"  and a long haul across the state to a big University Hep specialist, cause he's been totally compliant 100% on dosages that were at the top or above the top range for his weight.  Now my H is a half full type of guy so he thinks he's going to stay not detected and he's done mid-summer.  If that happens then he's the magic 1 percent or whatever it is and I'll be typing in more caps than NYGirl and I will begin to believe in the concept of mind over matter.  I'm just starting the homework on what can be added to the cocktail and what happens available if people relapse.

[jmjm530]

Our last two posts crossed. Hope it all works out and certainly his psoriasis should be better when off the treatment drugs, as interferon very often flares psoriasis.

-- Jim

[motheroffour]

I think the 48 vs. 72 is the most difficult of all decisions, even more difficult than do you treat or not.  Since it's H who has to take the pills, do the shots, ultimately it's his decision.  I'm guessing in the coming month as the 48 looms there is a possibility he might change his mind.  Fortunately his side effects have been nil with the exception of the cough and the reflux in the AM.  But he gets concened about the lasting effects of that much interferon over such a long continuous time.  He said no, no, no for almost 10 years to methotrexate for his psoriassis (in retrospect thank heavens) and suffered the consequences of really bad psoriassis and psoriatric arthritis in joints on the left side of his body. He's just not the "type" to go the 72 without extremely compelling medical evidence that it is the right thing to do.