Question
I am in Methotrexate for rheumatoid arthritis and was going to add enbrel, but my tuberculin test is positive since many years ago, with negative X-ray. How many months of Isoniazid prophylaxis should I take, and after how much time can I start the enbrel. Can methotrexate be combined with isoniazid? thanks.
Answer
HI Janira,
With a positive tuberculin (“PPD”) test, you must take isoniazid before administration of Enbrel or any other anti-TNF agent (TNF= tumor necrosis factor). The general recommendation is to take isoniazid for 9 months total. At Hopkins, we usually start Enbrel about 1 month after the isoniazid is started. However, other doctors may start the Enbrel earlier or later than with our practice. There are no data or controlled studies on this to guide us.
