Kelly:

i would also worry about every 2 months liver tests in this
case. Don't like that at all. Especially since you have had high liver
tests and with the combination of arava and mtx. I would run to that
rd.

ME:

Well, my labs have been coming back normal for three months (on Arava,
MTX and Sulfazine), that's why the doc moved it back to every other
month.

Called the 800 number, they say it isn't contra-indicated to be on
those three drugs and Enbrel, though the nurse did admit that there
were no studies of someone on Arava and Enbrel, but since it's *safe*
with most RA drugs...  with the exception of Kineret....

Called the pharmacy, and the pharmacist said he would call them, see
what answers her could get.  If he isn't satisfied, he'll give me back
my 'script so I can go to another pharmacy (HA, if *he* isn't
comfortable, I won't be either).  I'm thinking I won't be on Enbrel
until after I visit Dr. Sandy.  Here's hoping she is as good as I've
heard she is.

Smokie Darling (Annie)

Still are.
thumper

To reply drop XYZ in address

Monotherapy with Enbrel alone can be very effective for some people,
but combination is still very much in use.  Take a look at the
therapeutic guidelines from ACR:
http://www.rheumatology.org/publications/guidelines/raguidelines02.pdf
Note it lists both mono and combination therapy for the Biologics.  It
specifically  mentions mtx and etanercept.

My Dr recommends combination therapy with Enbrel  as do most
Rheumatologists in this area, however there are regional differences
in treatment.  If you can get manage with monotherapy great but for
many people it is not enough control. I would have had little to no
response to Enbrel alone.

Might take a look at this study in John Hopkins website, read  the
editorial comments about combination therapy:
http://hopkins-arthritis.org/edu/eular2003/ra-treatments-tnf.html

Also note that this was a fairly large study.
The next study  might have been a subset of the study listed above it
was published in the ACR 2004 program ( I copied just the results and
conclusions)

Results: 305 patients fulfilled the above criteria of whom 77 (25%)
were receiving MTX. The median age was 56 years (IQR 49-65), 80% were
female, and median disease duration 13 years (IQR 8-21). At baseline,
patients on MTX were in general younger (53 vs. 58 years, p<0.01), had
received one less previous DMARD (4 vs. 5, p<0.01), had lower disease
activity (DAS28 6.5 vs. 6.8, p<0.01) and had less disability (HAQ 2.03
vs. 2.30, p<0.01). The median dose of MTX was 15 mg (IQR
10-20mg)/week. Patients receiving MTX were less likely to discontinue
ETA before 6 months (10 MTX+ETA, 60 ETA alone, p=0.02). The majority
discontinued for either inefficacy or adverse events. Significantly
more patients in the combination group, 24 (31.2%) achieved a good
EULAR response after 6 months of therapy than those receiving ETA
alone, 24 (10.5%). After adjusting for baseline difference, the
benefit of concurrent MTX in achieving a good response was sustained
(OR 1.88 (95% CI 1.02-3.48)).
Conclusions: In this observational study of RA patients with
established severe disease, the response to ETA was importantly
greater when added to MTX than with ETA therapy alone, after allowing
for baseline differences. These data add to the clinical trial
evidence that this combination offers distinct therapeutic advantages

This is from medscape:
Abstract
Etanercept can be used both as monotherapy and in combination with
methotrexate (MTX), but direct comparisons of these two options have
not yet been reported. In order to compare the results seen in actual
practice between these two options, clinical data on 97 patients
followed in the Stockholm TNFa Follow-Up Registry were analysed. In 57
of these patients etanercept was added to previously started MTX while
the others were treated with etanercept alone. The two groups had
similar levels of disease activity at baseline. After 3 months, a
significantly lower mean disease activity score (28-joint count-based
disease activity score) was attained by the patients on etanercept
plus MTX. In this group, the number of patients achieving European
League Against Rheumatism-defined remission was also significantly
greater. Other disease outcomes showed non-significant trends in the
same direction. These data suggest that the combination of etanercept
plus MTX is clinically more efficacious than etanercept alone.

MTX +Arava+Enbrel is radical, my Dr will not Rx it,  but it is also
used.  It is great when monotherapy works.   -- MZ

Visit my website:
http://www.mzuschlag.com