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Failing Enbrel

I've been on Enbrel (stand-alone) for about 2 years. I felt pretty successful on it and all my blood markers were normal, so it seemed a great fit. Pretty suddenly, about a month ago, they found low WBC and low neutrophils in my quarterly bloodwork. They tested again in two weeks and confirmed it. Only symptom I ever experienced was fatigue. Rheum referred me to hematology. In the meantime while waiting for a hematology appointment, I had asked to go off Enbrel, as I was concerned it was the cause. My rheum said we could try that for a month, draw again, and see what my levels were. I ended up getting in to hematology quickly and had an appointment this last Monday. At that point I had been off Enbrel for 2 weeks. They drew a lot of blood and did a variety of tests. This time, my CBC w/diff showed everything in the normal range, except high levels of immature granulocytes. WBC rose from 2.78 two weeks prior, to 10.2 on Monday. Sed rate rose significantly in the month interval from 0 in early April at my quarterly bloodwork, to 40 this past Monday. No infections were found and vitamin levels were normal.

It seems to me that this whole saga was really just me failing my biologic. I haven't heard back from any doctors yet (frustrating, as I'm starting to flare having been off all meds for nearly 3 weeks now) on their conclusions. Has anyone had a similar experience failing a biologic?

  1. Biologics basically work by tamping down a part of your immune system and each one affects a different part of the system - TNF, b-cells, t-cells, etc. etc. The hard part is finding the biologic that affects the part of that immune system that your specific type of RA is being mainly caused by and this requires a bunch of trial and error. I think the main question you have to ask yourself is "did this medicine help my RA?" If it did, then you may want to have another conversation with your rheumy about possibly finding a way to stay on it. Unfortunately, living with RA is always a trade-off, a risk-vs-reward scenario. I'd love to give you a more definitive answer but that's pretty much par for the course, unfortunately. Whatever happens, please let us know what you decide and how it ends up going and remember - you're not alone. Keep on keepin' on, DPM

    1. Good morning! Previously I was on Orencia for a couple of years with great success. The effectiveness of this biologic stopped working and as explained by my rheumatologist, the effectiveness of biologics can have a short lifespan usually a couple of years. Not something we want to hear because if it was working what changed? I would have to say my RA was adapting and decided to change things up. There are so many biologic options out there to be discussed with your rheumatologist. Wishing you a speedy resolution soon! Take care, Sharon

      1. Hi . Sorry you have had this issue with your white blood count. It could be caused by the Enbrel. That said, there are numerous other possible explanations, including RA itself, so it is important to get the proper diagnostics. As noted, the trick is finding the proper treatment. If it does turn out that you have to discontinue the Enbrel, but you felt it helped, there are a number of other anti-TNF drugs that may be possibilities which your doctor can discuss with you. Wishing you the best. Richard (RheumatoidArthritis.net Team)

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