1. < Polymyalgia Rheumatica (PMR)
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LOW WHITE BLOOD COUNT FROM KEVZARA

Posted by sandranovicki74 @sandranovicki74, Feb 24 8:39am

I have been taking Kevzara injections for almost 2 years. My white blood cell count has dramatically decreased. Has anyone else experienced this? It was normal when I started the medication.

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caroljeand | @caroljeand | Mar 7 7:50am
In reply to @dadcue "@tweetypie13 "It is believed—and supported by clinical data—that IL-6 inhibitors (such as tocilizumab) reduce the absolute..." + (show)
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@tweetypie13
"It is believed—and supported by clinical data—that IL-6 inhibitors (such as tocilizumab) reduce the absolute neutrophil count (ANC) in the bloodstream by promoting the redistribution (or margination) of neutrophils out of circulation and into non-circulating pools, such as the bone marrow and spleen"

I don't really know but the following makes some sense to me.
https://pmc.ncbi.nlm.nih.gov/articles/PMC7376291/.
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The Absolute Neutrophil Count (ANC) is a subset of the total White Blood Cell (WBC) count. A lower circulating ANC almost always corresponds to a lower total WBC count. I was told as long as my ANC wasn't below normal I could safely stay on Actemra. There are other kinds of WBCs that have other functions.
https://my.clevelandclinic.org/health/body/21871-white-blood-cells
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The ANC decrease is because the IL-6 signal is turned off when we are on an IL-6 inhibitor. The cells aren't destroyed ---they go back into storage and aren't circulating in the blood. They supposedly come out of storage if we get an infection but we are still immunosupressed.

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@dadcue
So what does all this say if I am scheduled to go under cataract surgery while on Kevzara? Eye surgeon says to discontinue use 2 weeks prior and 2 weeks after both surgeries… that’s 6 weeks without injections. Rheumatologist doesn’t see it as a problem to continue use. I’ll see her on Monday.
Kind of makes me nervous.

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tweetypie13 | @tweetypie13 | Mar 7 8:25am
In reply to @caroljeand "@dadcue So what does all this say if I am scheduled to go under cataract surgery..." + (show)
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@dadcue
So what does all this say if I am scheduled to go under cataract surgery while on Kevzara? Eye surgeon says to discontinue use 2 weeks prior and 2 weeks after both surgeries… that’s 6 weeks without injections. Rheumatologist doesn’t see it as a problem to continue use. I’ll see her on Monday.
Kind of makes me nervous.

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@caroljeand
The Kevzara stays in your system for abt 2 months.
After you talk to Rehumy, if need be, ask eye Dr abt possibly extending time between eyes surgeries.

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caroljeand | @caroljeand | Mar 7 10:11am
In reply to @tweetypie13 "@caroljeand The Kevzara stays in your system for abt 2 months. After you talk to Rehumy,..." + (show)
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@caroljeand
The Kevzara stays in your system for abt 2 months.
After you talk to Rehumy, if need be, ask eye Dr abt possibly extending time between eyes surgeries.

Jump to this post

@tweetypie13
So I’m thinking if the benefit of kevzara stays in my system for two months I should be ok to be without an injection for 6 weeks to be on the safe side with the surgeries. Surgeries need to be done two weeks apart because new prescription glasses will need to be made.
I’ll see what the rheumatologist says Monday.
Thanks!

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Mike | @dadcue | Mar 7 11:06am
In reply to @caroljeand "@tweetypie13 So I’m thinking if the benefit of kevzara stays in my system for two months..." + (show)
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@tweetypie13
So I’m thinking if the benefit of kevzara stays in my system for two months I should be ok to be without an injection for 6 weeks to be on the safe side with the surgeries. Surgeries need to be done two weeks apart because new prescription glasses will need to be made.
I’ll see what the rheumatologist says Monday.
Thanks!

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@caroljeand

Not all of Kevzara stays in your system for 2 months. About half of it is gone in 2 weeks.

I don't know anything about cataract surgery while taking Kevzara. I would do what you are doing by talking to your rheumatologist and trying to do what the eye surgeon wants.

I had cataract surgery done on both eyes about 30 years ago. I was only 40 years old at the time. My cataracts progressed rapidly and early because of Prednisone. I was devastated about having cataracts when I was so young. My left eye progressed faster than my right eye so my cataract surgeries were a year apart.

I didn't need glasses after my cataract surgeries. I still only use reading glasses. It is amazing to me that the artificial lenses I have are the ones that were implanted 30 years ago.

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tweetypie13 | @tweetypie13 | Mar 7 11:13am
In reply to @dadcue "@caroljeand Not all of Kevzara stays in your system for 2 months. About half of it..." + (show)
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@caroljeand

Not all of Kevzara stays in your system for 2 months. About half of it is gone in 2 weeks.

I don't know anything about cataract surgery while taking Kevzara. I would do what you are doing by talking to your rheumatologist and trying to do what the eye surgeon wants.

I had cataract surgery done on both eyes about 30 years ago. I was only 40 years old at the time. My cataracts progressed rapidly and early because of Prednisone. I was devastated about having cataracts when I was so young. My left eye progressed faster than my right eye so my cataract surgeries were a year apart.

I didn't need glasses after my cataract surgeries. I still only use reading glasses. It is amazing to me that the artificial lenses I have are the ones that were implanted 30 years ago.

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@dadcue
I second your thoughts Mike.

In reply to @caroljeand …..
You might want to check your timing with eye Dr again after meeting with your Rehumy.
My Cataract surgery, RX glasses are not usually done for some time to let the eyes adjust. They had me using over the counter ones for (my memory?) at least 2 months

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caroljeand | @caroljeand | Mar 7 12:37pm
In reply to @tweetypie13 "@dadcue I second your thoughts Mike. In reply to @caroljeand ….. You might want to check..." + (show)
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@dadcue
I second your thoughts Mike.

In reply to @caroljeand …..
You might want to check your timing with eye Dr again after meeting with your Rehumy.
My Cataract surgery, RX glasses are not usually done for some time to let the eyes adjust. They had me using over the counter ones for (my memory?) at least 2 months

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@tweetypie13
Right, but the closer they are done together the closer you are to getting the glasses.
Can’t wait to get this over with!

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caroljeand | @caroljeand | Mar 7 12:43pm
In reply to @dadcue "@caroljeand Not all of Kevzara stays in your system for 2 months. About half of it..." + (show)
Profile picture for Mike @dadcue

@caroljeand

Not all of Kevzara stays in your system for 2 months. About half of it is gone in 2 weeks.

I don't know anything about cataract surgery while taking Kevzara. I would do what you are doing by talking to your rheumatologist and trying to do what the eye surgeon wants.

I had cataract surgery done on both eyes about 30 years ago. I was only 40 years old at the time. My cataracts progressed rapidly and early because of Prednisone. I was devastated about having cataracts when I was so young. My left eye progressed faster than my right eye so my cataract surgeries were a year apart.

I didn't need glasses after my cataract surgeries. I still only use reading glasses. It is amazing to me that the artificial lenses I have are the ones that were implanted 30 years ago.

Jump to this post

@dadcue
The prednisone definitely affected my cataracts in such a short period of time.
Amazing you have had the same lenses after so long.
I might push to err on the side of the eye doctor and risk being off kevzara for the surgeries. It’s such an unknown to predict and I definitely want a successful outcome. Hopefully getting back on Kevzara won’t be a big deal.

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Mike | @dadcue | Mar 7 3:09pm
In reply to @caroljeand "@dadcue The prednisone definitely affected my cataracts in such a short period of time. Amazing you..." + (show)
Profile picture for caroljeand @caroljeand

@dadcue
The prednisone definitely affected my cataracts in such a short period of time.
Amazing you have had the same lenses after so long.
I might push to err on the side of the eye doctor and risk being off kevzara for the surgeries. It’s such an unknown to predict and I definitely want a successful outcome. Hopefully getting back on Kevzara won’t be a big deal.

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@caroljeand
"Hopefully getting back on Kevzara won’t be a big deal."
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I was on weekly injections of Actemra when I was being considered for a major lumbar fusion surgery. The spine surgeon said I needed to be off Actemra for a month before surgery and a month after surgery. It wasn't too much of a problem for me to go 7 weeks without an injection but my PMR symptoms and inflammatory markers gradually increased. It wasn't a sudden overnight flare like when I was on Prednisone.

Seven weeks wasn't enough time and my back pain got worse. The idea was going 2 months between Actemra infusions might be easier. I was switched to an infusion and that quickly relieved my pain. We gradually increased the time between infusion and I probably could do2 months between infusions if I had to. The funny thing was another CT-Scan was done prior to surgery. The reason I was having the surgery was because a large synovial cyst had formed on my lumbar spine. It is rare for a synovial cyst to be reabsorbed.
https://pmc.ncbi.nlm.nih.gov/articles/PMC11278635/.
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It could have been just a coincidence but I think the Actemra infusions played a role. Synovial cysts are usually caused by inflammation. In any case, surgery wasn't urgently needed anymore.

I still have severe spinal stenosis but the spine surgeon said surgery for spinal stenosis could be delayed. It has been delayed for 3 years. I don't intend to call the spine surgeon anytime soon. I just plan on doing the monthly Actemra infusion like my rheumatologist strongly recommends.

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