so confused as what to do?

What do I do?
0
Remicade - 0.0%
1
Enbrel - 100.0%

 
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tiredofthis1
New Member


Date Joined Aug 2010
Total Posts : 2
   Posted 8/4/2010 8:59 AM (GMT -7)   
I was diagnosed with RA a year ago, and then with Fibro 6 months ago. The RA has since progressed at what I think is a rapid rate! My Rhuemy has given me the choice to start either Remcicade or enbrel. Does anyone have any advice on which one is better or has less side effects? Are they lifelong or could they be stopped later on? Thanks for your help I am so overwhelmed and just want to feel better. P.S. I do have a toddler to take care of so as little fatigue and nausea would be ideal, but I know that prob is not an option.

JayBespoke
Regular Member


Date Joined Jul 2010
Total Posts : 297
   Posted 8/4/2010 1:10 PM (GMT -7)   
Right, personal experience first: I've been on Etanercept (Enbrel) for quite a few months, and the only side effect I've noticed is being tired the next day. Although I wouldn't describe this as fatigue, and it's nothing compared to the fatigue I get from MTX. I've had pretty good results from it, and I am continuing to do so.

You could be taking either medication for a great number of years, or not very long at all if you were lucky enough to go into partial or complete remission. The side effects last 24-36 hours usually, but depends on my level of activity and general energy levels.


Sciency Bit:

TNFa stands for Tumour Necrosis Factor, and these are cytokines, which are pretty small proteins which send low-level signals between cells. TNFa cause the 'acute phase reaction' which tells your body's immune system to respond to injury at that site, which through a chain reaction from inflammatory cells to the liver, results in inflammation, and therefore pain. The aim of these meds is to inhibit the effect of the TNF alpha cytokine.

Etanercept/Enbrel is a protein that is synthesis(z)ed by splicing two genes (which produce two different proteins when separate). It acts as a decoy for the TNFa, mimicking so-called "soluble" TNF receptors in your body which inhibits the TNF's effect. These serve to 'deactivate' the TNF, whereas the receptors in your white blood cells produce cytokines which result in inflammation when they bind to TNF. The increase in these 'deactivating' sensors will reduce the overall inflammatory response experienced.

Infliximab/Remicade is an antibody (Enbrel isn't strictly an antibody, it is a fusion protein, but functions as the 'tail' of an antibody), as is Humira. Both are thought to have the same mode of action as Enbrel, but this isn't confirmed as far as I know. (Remicade also has action on a specific type of T white blood cell which results in the cells suicide, which means it also has efficacy in treating Crohn's disease. Whether Enbrel does is up for debate.)

Both are immuno-supressents, but with fairly good side-effect profiles. There will be tiredness, but how much depends on the individual.

To be honest I'm not sure how doctors choose between the two, I know some clinics will start with Enbrel, and others with Remicade. In my opinion, it doesn't really matter which you choose as there is currently no mechanism in predicting which will suit any given patient more. The NHS in England tend not to try the other if one fails, but that is because the NHS is the biggest joke in the history of comedians. (/rant)

That just about sums up my knowledge on the subject. Hope I helped a little, if not, sorry!

James

P.S.

I'm not a doctor so this doesn't constitute medical advice!
21, Male, England.
Dx: Psoriatic Arthritis, Chronic Back Pain, Dyspraxia
Rx: 25mg Methotrexate Sub-Cut Injection & 50mg Etanercept (Enbrel) Sub-Cut Injection

Oh, and plenty of Tramadol, Codeine, Diclofenac, Diphenhydramide, Paracetamol, and SCOTCH.

Post Edited (JayBespoke) : 8/4/2010 2:20:10 PM (GMT-6)


golitho
Veteran Member


Date Joined Sep 2008
Total Posts : 1670
   Posted 8/4/2010 5:22 PM (GMT -7)   
Hi Tired, you got a really extensive response from James, but really both meds are good for RA IF THEY SUIT YOU. and thats the problem, each of us has an individual response to these meds. I tried remicade and it did nothing for me apart from give me horrendous side effects, yet I know others on it for over 10 years and swear by it. The positives of remicade is you only need it every 6 or 8 weeks but then its an infusion so you need to go to a centre or hospital to get it while enbrel is a 2 x week injection which you can do yourself, so much easier to administer but more frequent. Which do you feel happier doing?

I was on humira, that really suited me initially, but stopped working after I had my ovaries removed for another condition. Now I am on Orencia (abadacept) which is a once monthly infusion. Talk to your rheumy and see what they reccomend, they are both good, both proven, its a hard choice to make because we'd rather not be on any of them but they can be miracle meds and really give you your life back, its definately worth the try.

Best of luck with your decision, golitho

mama6
Regular Member


Date Joined Jul 2010
Total Posts : 416
   Posted 8/4/2010 9:34 PM (GMT -7)   
I don't know, I won't know what they want to do until August 20th. that is my looming day. Having a toddler is difficult enough, even when it's the best of babies. I have read and heard good about both.I know this doesn't answer your question, or help. Whatever you decide you will be in my thoughts and prayers. Gentle Hugs sent your way. Heather
Mama6

JayBespoke
Regular Member


Date Joined Jul 2010
Total Posts : 297
   Posted 8/5/2010 4:16 PM (GMT -7)   
Oh yep, I should have mentioned - Etanercept is a weekly or bi-weekly injection, whereas Remicade is an infusion every few weeks - so your personal preference and locality to hospital will play a part in your decision!

James
21, Male, England.
Dx: Psoriatic Arthritis, Chronic Back Pain, Dyspraxia
Rx: 25mg Methotrexate Sub-Cut Injection & 50mg Etanercept (Enbrel) Sub-Cut Injection

Oh, and plenty of Tramadol, Codeine, Diclofenac, Diphenhydramide, Paracetamol, and SCOTCH.

sjkly
Veteran Member


Date Joined Dec 2007
Total Posts : 2113
   Posted 8/5/2010 6:05 PM (GMT -7)   
If you have ever had iritis then go with Humira, other wise I don't know much about specific differences-look at what your insurance covers, what your co insurance would be and the dosing schedule and see what you like best.

tiredofthis1
New Member


Date Joined Aug 2010
Total Posts : 2
   Posted 8/12/2010 4:49 PM (GMT -7)   
Thank you all so much for your responses. It means alot, since it doesn't feel like my husband cares a whole lot, but I do know that its kinda hard since its not something he can see. My parents have been real supportive but they are 5 hours away so its hard. I have chosen to do the remicade so hope it goes well. Thanks again!

golitho
Veteran Member


Date Joined Sep 2008
Total Posts : 1670
   Posted 8/12/2010 9:02 PM (GMT -7)   
Take your husband with you to the next rheumy appt, I think mine was in denial initially, gave me a hard time because I was taking so many pills. Now he is so supportive. I don't think he knew what RA was or what its impact would be. So if I was you I'd educate him, gently of course. Hope this helps, golitho
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