Prescribed Tymlos after Evenity

I spotted some papers that seemed to refute this but I trust drugs.com to not publish something without basis. And Amgen would be on their case if the info were incorrect.

This information is anecdotal, gleaned from doctors I've spoken with. That concern is probably influenced by the occurrence of osteosarcoma in female rats. Nonetheless, many doctors prefer to cycle off of anabolics in part to avoid this issue. Very simply put, the theory is that it's best to build bone, then focus on maintenance/antiresorptives , evaluate DXA and TBS and then consider re-introducing an anabolic. Since Evenity is so new, the protocols are not yet firmly established.

But Evenity is not anabolic in the last 6 months, it is antiresorptive (less so than bisphosphonates).

@normahorn and @awfultruth my doctor agreed ( a few years ago) about Prolia'spotential effects on the immune system. It is one reason it was not prescribed (rebound being the other one). I have lupus and various allergies and generally have an unhealthy immune system so it was a concern.

People are focused on cardiovascular risks with Evenity but I read a study that said other issues needed research including the effect on B cell (acquired) immunity and bone marrow edema. Most don't have any problems on it but there may be a few who are vulnerable. Ditto side effects with other drugs.

I need an advice. I was on Evenity for a few months but had a very bad allergic reaction. My back hurting more than before, hives, headaches, etc. I found a new doctor who prescribed Tymlos and told me to start right away. ( I have very severe osteoporosis case) . It has been just 3 weeks since my last Evenity shot and pharmacist told me to wait and let Evenity to wear out at least 2 weeks .Not sure who is right in this case. Anyone have any thoughts?

sunny65, your physician is concerned that you have the soonest protection from fracture possible because your osteoporosis is severe. The pharmacist is concerned about a possible reaction from Tymlos in addition to the reaction from Evenity. Maybe!
The mechanisms by which these medication increase bone density are different. The half life of evenity is 12 days, it can remain in your system for two months. (68 days)
I vote for the doctor's advice, though I might quiz them both.
Best luck with Tymlos, my layperson's opinion is that it will be a much better medication for your bones.

Hi @sunny65 I like @gently's analysis. Your pharmacist probably was thinking to allow your blood level of evenity to go down further before you start tymlos. However, you know your body best and you are the best judge of the readiness of your body to take on a brand new medicine. When you are ready, the ramp-up method described by windyshores could be very useful. You will be among the few doing this sequence. Wish you a great success and please keep us posted!

Hello @mayblin , thank you for encouragement. I been having debilitating back pain for the last 9 months. It started before Evenity but intensified with every Evenity shot. In November it became totally unbearable. No medication helping me. It’s very hard for me to make a decisions because I am in pain all the time. But you are right - I have to listen to my own body. I know that I have to wait in order to understand if some of my pain is contributed by Evenity.

I’ve read every post on this thread and still don’t understand if anyone in this group started Tymlos after Evenity without waiting period and what was the outcome. My doctor suggested to stop Evenity after 7 shots due to allergic reaction and go to Tymlos. I am very confused by him saying no waiting time just start right away. He doesn’t give any tests or anything else. I am so afraid that this somehow make my back pain or bone density even worse .

@sunny65 my doctor wanted me to wait, as I said. I assume your doctor is at least having you wait a month after your Evenity shot. Is that right?

Bottom line would seem to be avoiding interaction between the two. Half life of Evenity is 12.8 days so waiting a month after the shot would be good based on that- so that Evenity is out of the system, but confirm with MD.

ps Just remembered that Evenity can be taken with an interval of up to 6 weeks! So 6 weeks from the last shot should be okay. You can discuss this with your doctor!

My world class endo said it takes awhile for Evenity to mineralize so he okayed waiting two months after the last shot, before doing Reclast. Since Evenity is new (2019) and the transition to Tymlos is unusual, it seems noone really knows for sure.

Bottom line: Tymlos worked well for me and I hope it works well for you regardless of timing. If it were me, I would split the difference (Don't you have another provider suggesting longer?) and do Tymlos 5-6 weeks after the last Evenity but that is NOT medical advice. I hope you can ask your endo what consequences they see from waiting an additional week or two. Let us know because we are all learning!

@sunny65 I don't know if you've been approved for Tymlos yet, but that process usually takes a while. Perhaps that in and of itself will be a major factor contributing to your decision. I'd also like to mention that when I started Tymlos, my metabolic bone specialist instructed me to start with a lower dose. The Tymlos pen has a delivery system that allows you to very easily adjust your dose. I started with 20mcg, and increased the dose by 20mcg every three days until I reached the full dose of 80mcg every day. This decision was based on my medical history, but I think it's worth noting. So far, I'm tolerating the Tymlos very well and will have my next DEXA in March and will report my results here. I would guess that any testing done for your response to Evenity would be inconclusive as you didn't complete the full course, but that's certainly something to discuss with your doctor. Best wishes to you.