Enbrel or Methotrexate? Pros/Cons

[lchia]

so i think most folks have received their approval for enbrel by now, who were on the waitlist. but for the first time since i signed up for enbrel, i am starting to question whether methotrexate or enbrel are better, given the recent safety warnings issued by amgen/immunex regarding the potential for severe infection, nerve damage, etc. efficacy-wise, they have similar profiles. safety-wise, enbrel has a better safety profile given clinical trials and such, but the long-term effects, ie infections, are still unknown. whereas methotrexate, though potential side effects exist, is still the "devil that we know," and know how to administer safely.

so what do folks think? pros and cons? which would you choose to go on to slow the progression of PA, if you haven't been on either? also, i know we're not supposed to drink on meth? does anyone else consider that a con besides me? :)

[lapradef]

Dear Ichia --

Forgive my ignorance, but doesn't Enbrel cost about 100 times what MTX does? Even if you're fully insured, I'd think your carrier would insist on trying the MTX first. Of course, you should insist on the one your doctor says will be most effective.

All I can tell you that my wife, with RA, has been on a MTX regimen (combined with several other drugs, most of them inexpensive, such as folic acid) for about five years, and she feels absolutely great. Occasionally, she will experience an hour or so of mild nausea right after taking a dose, but that's always resolved with a little nap.

And finally, she still enjoys a couple of rums and Coke in the evening. She has to submit to blood tests about every six weeks, but, so far, no problems. I don't know if she's typical or not, or whether her experience would translate to PA, but her doctors are very pleased.

In any event -- good luck.

GL

//////

[Stormrider]

You should not drink when on MTX because it concertrates in the liver and cause some problems. I have been on just about all drugs-98% coverage for 25 years. MTX sometimes lower your platets(red blood cells) and drinking lowers them more.Your liver will repair itself but platets take years to rebuild if at all.
MTX like all drugs do not effect people the same way,but as a precautionary method I would not add to harm that drugs do already.
I wish you the best.

[web63]

If I am not mistaking, you will use MTX while on Enbrel. That is how my Rheumy has set it up for me.
I have been on MTX for over a year, and have been on Remicade this entire year with double doses every 6 weeks.
My insurance company made me start with all of the NSAIDs first, then work my way up the ladder with DMARDs. MTX, Remicade, and now Enbrel.

Good Luck,
Scott in Atlanta, GA

[rosee_posey]

Howdy All,

Nods to Scott (web63).

Enbrel and Remicade are CHIMERIC (from Chimera, meaning "an individual, organ, or part consisting of tissues of diverse genetic constitution.") In other words, part of the drug is made from a mouse antibody. Yes, there are "mousie bits" in there!

This is good and bad; the mousie bits are the part that makes the drug work; however, your body may detect the mouse bits, treat them as a foreign substance, and build antigens to it - making the drug ineffective. The chance of you building antigens to either drug is minimal; but, as an extra precaution, a doctor may also prescribe MTX (or some other immunosuppressant)WITH Enbrel/Remicade to minimize this risk. I am taking MTX and Remicade together.

SO - to answer ichia's question, "which is better?", there's really no comparison - it's like apples and oranges. Most doctors would try MTX first - it's been around for years and years, and everyone knows what the long term effects are. MTX is much easier to take than Enbrel (oral vs. self-injections) and yes, it's much cheaper and easier to get.

Hope this helps,
- rose

[Pati01]

Hello to all just wanted to let you know that about 8 months ago I was taken off MTX because of a bad liver biopsy. So far I have had 2 Enbrel injections the improvement of my PA is amazing, and my P which is 80-90% is slowly but surely showing improvements. I am so excited this is working so well... and no more liver screenings.....

[EdR]

Hi all,

I just wanted to mention that although Remicade is chimeric, Enbrel is not. Enbrel is the fusion of a human TNF receptor to a subsection of a human antibody. So, use of MTX is not "required" when using Enbrel.

(Large pdf file):

http://www.fda.gov/cber/label/etanimm091202LB.pdf

EdR

[rosee_posey]

Oops! My Bad, Ed!

Thanks!

- rose

[rosee_posey]

Hey Ed,

I just took a long peek at that PDF file you sent - and while you are correct that Enbrel is not Chimeric, there is still a small possibility of autoantibodies being produced from it. It's on page 18 (under "autoantibodies".)

Scary, huh?

I'm not sure if this would warrant MTX being administered with Enbrel, but I'm surprised that a dimeric would also cause this side effect to occur. Do you think it's cause they make it in a hamster? Hmmm. I'll go ask my pipeline, you go ask yours.

- rose