It seems like perispinal enbrel injection might work better and quicker (thanks for the links). Perhaps perispinal might work if SC injection doesn't. The most common response pattern for SC use is a little longer, weeks to months. Mella/Fluge writes some interesting paragraphs about it: "An alternative for patients with typical CFS / ME illness strict diagnostic criteria, but no response after Rituximab, the use of a TNF inhibitor Enbrel. In autoimmune diseases like arthritis seen the effects of illness often after a few weeks, as this is mediated via the elimination of the cytokine directly". (nice to see their opinion is that cytokines reactions might be central in generating the symptoms) (...) There are no published scientific published study that evaluated the use of Enbrel in CFS / ME. However, there is a contemporaneously where six CFS / ME patients had been treated with etanercept with good clinical effect, but these results have not been published later (Lamprecht K. American Association of Chronic Fatigue Syndrome, Seattle 2001). In addition, individual patient unpublished stories available (link). Kristin says the following about Enbrel: "I was in a “pre-study” with Enbrel back in 2000. I have CFS-moderate. For the first weeks-nothing. Week 5-8 I felt wonderful. Not completely normal, but SO much better. I cried when I had to stop at 8 weeks and found out the cost of Enbrel. What I would not give to see Enbrel further studied and approved for CFS treatment. (link)" I am actually trying to get on it now. If you'd like I could PM you with info on how it goes. I barely write about these things in public, since I really don't want attention to it - even though the web is anonymous. By the way, I really like your approach with thinking out load. I think tossing ideas back and forth are key to moving forward. The more knowledge one gets about mechanisms, the less fumbling in the blind it becomes. Although I wouldn't recommend to anyone else taking RTX or equivalents, it seems like India is a better alternative than Spain if getting it at a hospital at a reasonable price is the objective. When dispensing RTX, they need an ER at the hospital, just in case - but it's rare that it's actually needed. It's standard procedure to give cortisol just before the RTX to minimize such risks. Dr. Reddy's Laboratories being a publicly traded company, is reassuring.