Prescribed Tymlos after Evenity

@hollygs I am finding that some doctors just don't want us to do anything that hasn't been studied thoroughly and Evenity is so new (approved 2019) that studies are lagging behind our need for answers.

I was originally told the reason not to do Tymlos after Evenity (okay the other way around) was because Evenity "turbocharges" bone growth so there is little left for Tymlos to do. This no longer makes sense to me since many of us need more bone growth after the one year on Evenity.

My doctor is pretty renowned in the field and will not use Prolia, at least unless absolutely necesssary or a person is 85+.

The thing about Fosamax is that it reduces the effectiveness of Forteo, Tymlos and Evenity.

Can you get back on the plan you were on so you can still see the same doctor? Can you ask him or her directly about effectiveness of Tymlos after Evenity? Evenity inhibits sclerostin and takes a little while to mineralize- my doctor's words exactly. Tymlos works through the parathyroid. Since their mechanism is so different I am very curious why Tymlos cannot be taken after Evenity,. Please let us know what you found out!

Hi @hollygs the treatment sequence of evenity then tymlos (or forteo) is very rare, although not unheard of. One of my online acquaintances is doing just that currently but dxa not due yet. I read another case online. S/he had a nice gains after evenity --> forteo although different dxa machines were used. Like @windyshores mentioned, clinical studies do not appear to be available for this particular sequence yet. For the time being doctors have to rely on their clinical experiences and judgements, or sometimes use most updated case reports from either their colleagues or publications to make a decision. Hope everything will work out smoothly for you.

@hollygs,
Antisclerostin antibodies (Evenity) and abloparatide (Tymlos) can have an additive effect. Evenity blocks sclerostin. Tymlos depletes sclerostin using it to produce the cells that build bone. This unproven caution about is why you might not want to take Tymlos while Evenity is still active in your system. Evenity is thought to be gone from your system within 64 days after your last injection. So:
The unexamined question about Tymlos after Evenity no longer applies in your situation.
In my opinion you could be best served by continuing to take Tymlos for the remaining 4 months. Then I would want a second year of Tymlos.
I don't have experience with either medication.
Prolia and Fosamax can put your dental work at risk for osteonecrosis. Tymlos will protect your jaw bone and speed healing.
Your situation is actually ideal. You are safe now with the Tymlos and you have 4 months to find an endocrinologist who will prescribe a second year. Best wishes

@windyshores Thank you so much for your reply. To answer your question, changing my insurance plan won't help as the doctor who prescribed Tymlos doesn't take Medicare at all. I will contact his office today to find out what private pay will cost. I can also contact the infusion center where I received Evenity as they accept my insurance and find out if any of their affiliated doctors are familiar with using Tymlos after Evenity. The concern regarding doing so is that patients will have an increased risk of osteonecrosis/osteosarcoma, but that is conjecture as there aren't any studies available. I will certainly let you know what I find out!

Has your doctor filed an "opt-out" request with Medicare? If so, your Part D drug coverage can still be used.

@mayblin Thank you so much for your reply. I'm so glad to read that the Evenity - - > Tymlos sequence is not unheard of. Both Amgen and Radius have stated to me that there are no studies regarding that sequence available at present and, as of yet, I haven't found any information online. That being said, you're so right in saying that "doctors have to rely on their clinical experiences and judgements" and I was fine with that before experiencing my new endocrinologist's meltdown. Now I've regrouped and will calmly move forward!

@gently I have never heard that Tymlos "depletes sclerostin." That is important information when thinking about a sequence either way. Can you share a source?

All I know about Tymlos is:
Tymlos (abaloparatide) is a man-made version of a protein related to the human parathyroid hormone (also called parathyrin). Parathyrin is important in bone remodeling where bone tissue is resorbed...

Since Evenity takes time to mineralize (my doc's words) my doctor said I could wait two months (but no longer) before starting Reclast. The same might be true for Tymlos.

We need more research quickly but with Evenity on the market only 5 years or so, it is going to take time. Initially doctors didn't even know that it's anabolic effect was short-lived.

I did Evenity for only 4 months. There are studies I have seen that test doing short bursts of Evenity between other drugs, and also doing Reclast at the 6 month point on Evenity because at that point Evenity, like Reclast, is anti-resorptive.

@hollygs I have not seen or heard of any increase in risk of osteosarcoma with a combination of Tymlos and Evenity, going in either direction. The risk with Tymlos and Forteo has not proven to be valid. Risk of osteosarcoma has not come up with Evenity, to my knowledge. So I am curious why a sequence of these would raise risk- regardless of which comes first.

As for osteonecrosis, Tymlos does not contribute to that since it is not anti-resorptive. Evenity is anti-resorptive for the last months but mildly so. So not sure where that concern comes from either. If you have heard this, I would love any information.

@gently Thank you so much for your reply. After being fear-bombed by my new endocrinologist, I settled down over the weekend. I came to the same conclusion as you expressed here, and I really appreciate the succinct and gentle way you broke down your thought process for me. It makes sense to me, and I will calmly move forward with the original plan. It's so empowering to have your kind support and that of the others @mayblin and @windyshores who replied to me. I'm so very grateful. Best wishes to you as well.

Thanks again! I may not be understanding something here, but I'll just say that so far, Tymlos has been covered by my insurance and the prescription was for one year. The prescribing doctor doesn't take Medicare, so when I'm finished with my first year of Tymlos I will need a new doctor who is on board with my treatment plan. It's possible that I can just pay out-of-pocket for my former doctor or perhaps the hospital where he practices can provide assistance.

Another "thankyou" to all who have dug into the research and experiences related to osteoporosis! I'm 18 months on tymlos, last dxa showed improvement, starting to consider what next.. endo docs come and go, rarely in person. I'm 80, active, healthy..