Re: Enbrel, Remicade and immunosuppressants/ post from H

[Guest guest]

Here is a post from H that she wanted me to pass on.

Hi ,

The little article below came up on the PAN list and since some of the RP folks are taking Enbrel this may be of interest.

There may be new warnings about these and other T-cell receptor drugs at the web sites for the drug manufacturers. Since they mention drug-associated lymphomas after transplant I would guess that Cytoxan and Imuran -- given to transplant patients -- are probably not "compatible" with Enbrel and Remicade. It may be worthwhile to look for any mention of problems for patients taking Methotrexate with either.

My doc said if he changes my meds he will put me on CellCept instead of Cytoxan. That is another transplant-related drug but I don't yet know much about it....if it is an alternative for RP.

We are having high 50s and low 60s and still no real snowstorm to wet down the ground. I like the mild weather but am not looking forward to another summer without flowers if we don't get some rain or snow soon.

Happy New Year!

Etanercept and Infliximab May Be Associated With Development of Lymphoma

NEW YORK (Reuters Health) Dec 23 - The tumor necrosis factor (TNF) antagonists etanercept and infliximab may be associated with lymphoproliferative disorders, according to a review of MedWatch reports.

Dr. M. Miles Braun and colleagues, from the US Food and Drug Administration and the National Cancer Institute in Rockville, land identified 26 reports of lymphoma subsequent to the initiation of anti-TNF therapy between May 1999 and December 2000. Between November 2001 and September 2002, another 68 cases reported to the FDA's passive postmarket adverse event reporting system were classified as "probable or possible" associated with these two medications.

In the December issue of Arthritis and Rheumatism, the researchers thoroughly reviewed data from the earlier cohort. Indication for TNF antagonist use was rheumatoid arthritis in 18 of the 26 cases, psoriatic arthritis for 2, and Crohn's disease for 5 cases. For one case the indication was not specified.

Among the 18 patients given etanercept, lymphoma was diagnosed a median of 8 weeks (range 2 to 52 weeks) after starting therapy. The median duration of treatment with infliximab before diagnosis was 6 weeks (range 2 to 44 weeks) for 7 of the 8 cases.

"Currently available data do not permit us to draw definitive conclusions regarding whether these TNF antagonists were the proximate cause of the reported lymphomas, whether these neoplasms developed as part of the natural history of the underlying medical conditions, or whether they occurred as a complication related to other immunosuppressive medications to which these patients were exposed," the investigators write.

Further implicating the antagonists was the "striking" observation that the latent period was quite similar to that associated with lymphomas that develop following immunosuppressive therapy for patients who receive organ transplants, the investigators note.

Dr. Braun's group identified two patients previously treated for lymphoma who relapsed "very quickly" after being started on anti-TNF therapy. Therefore, they suggest that such individuals be considered ineligible for such treatment, at least until this issue is clarified.

They also found that in two patients, one treated with etanercept and one with infliximab, there was regression of their lymphoma once treatment was discontinued. Patients should be monitored for "spontaneous remission" after withdrawal of the agent to see if cytotoxic chemotherapy can be avoided, "if the patient's clinical condition permits," they add.

Finally, Dr. Braun's group urges clinicians to report similar cases to MedWatch with as much clinical detail as possible.

Arthritis Rheum 2002;46:3151-3158.

[Guest guest]

Okay explain in 's language what this means.

My Dr. kept me on the cytoxan and started the Enbrel also. SO what

does this mean. Thanks for any input.

Concerned lil ol me in Texas,

> > folks are taking Enbrel this may be of interest.

> > There may be new warnings about these and other T-cell receptor

drugs at

> > the web sites for the drug manufacturers. Since they mention

> > drug-associated lymphomas after transplant I would guess that

Cytoxan and

> > Imuran -- given to transplant patients -- are probably

not " compatible "

> > with Enbrel and Remicade. It may be worthwhile to look for any

mention of

> > problems for patients taking Methotrexate with either.

> >

> >