Etanercept

You just need to know that etanercept, its mechanism is it's a recombinant receptor against soluble TNF-alpha.

It mops up TNF-alpha.

Etanercept? Wrong fucking answer.

And then as we started making progress in fibromyalgia, some of those patients also had rheumatoid arthritis.

And the biologics showed up first out of Seattle with Enbrel in 1998.

And we observed very quickly that if you treat the sleep of fibromyalgia with something that stores normal sleep by blocking the stress response, the treatment for the autoimmune disease worked much, much better.

Wow, okay.

They helped a little bit, not a great deal.

And they put him on another very, uh, new drug called Enbrel, which is $15,000 a year to, of your taxpayers' money.

And, uh, and that sort of helped a reasonable bit, enough for him to, to play cricket again.

So he was, uh, on this Enbrel, he would have an injection every three weeks...

Every two weeks, every 14 days, he would need an injection of this, uh, of this Enbrel.

And he used to say to me, he said, "Oh, I, I used to know when it was time to get, uh, my injection, 'cause after about 10 or 11 days, my knee would start to ache again," and, uh, and so on.

So, uh, he came up to me at this, uh, on this tour and said, "Look, I'd like to try your diet." Because he p- he was a little bit overweight.

Well, we'll try the, try the diet." Anyway, he went hardcore.

And, you know, things like Ubrel-V and Amovig and that they were coming along.

And that everybody anticipated that those products were going to be priced by the pharmaceutical companies equivalently to things like the TNF-alpha antibodies, like Enbrel and Remicade and Humira at $30,000 a year.

And there was great fear among the insurance companies that that's where these pharmaceutical companies were going to price it and that they were going to end up having to write humongous checks.

And two things happened.

And the pharmaceutical companies do this all the time.

In fact, Novartis, not to get us off topic here, Novartis came to the market with the first bio-equivalent to the...

Humira, Enbrel, Remicade, TNF Alpha antibody, which sell for $30,000 in the United States.

Meanwhile, in Denmark, it's $300.

So it was definitely a really big challenge in schools.

So Molly, eventually, you know, I think Dr. Mehta switched you, started Enbrel.

So was the methotrexate stopped at that time and Enbrel was started or was Enbrel started in addition to the methotrexate?

And methotrexate was stopped.

Well, so methotrexate was stopped.

work.

And so we went back to Dr. Mehta and said, I know she wants the oral medication.

However, you said Enbrel first.

Yeah.

And I would say like a patient who has really active, say like, you know, psoriatic arthritis and they're taking their Enbrel, they are actively immunocompromised and they are more prone to getting like a viral pneumonia that turns into a bacterial pneumonia and we worry they're going to like land in the hospital.

But if they go into remission and they're off Enbrel, they're not immunocompromised in the same way.

Right.

I would, you know, so there are different things, but you know, I would say like in general, depending on all of your risks, right? Like we know when patients have like diabetes or they're elderly, we're always cautious and saying like your immune system is not exactly what it should be.

Yeah, you're right.

Like I know, um, Yeah, 90s, as you're saying, like Enbrel was like the big thing.

Yeah,

yeah.

We didn't have a lot

out

there, so Enbrel was really good.

Yeah,