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Cost of generic imitrex ate vs. cetuximab, and their findings were similar to ours, but their study was smaller with fewer patients (12). We also compared the response to first, generic imitrexate and cetuximab combination on a subgroup with high-resolution CT before dosing and 2 days post-dosing to control for possible dose- or time-dependent effects. In their study, they also compared these 2 agents in patients with different baseline rates of disease progression, and found that cetuximab was more effective at delaying disease progression in patients with a high baseline rate (6). However, when we repeated these analyses, found no difference in the overall response by disease progression, which suggests that the subgroup of patients with a worse disease progression did not benefit from the Imitrex 25mg $580.94 - $4.84 Per pill 2 drugs. A follow-up study was required to examine the effect of cetuximab on overall responsiveness, but the results of that study were inconsistent. We did not observe improvement in overall response after 12 weeks for either agent (data not shown), but it appears that both do have similar efficacy for the subgroup of patients with a worse disease progression compared to the subgroup with a good initial response to imitrexate or cetuximab. Our study has several limitations. First, this was small study in which data on several important outcomes may be limited. For example, because we did not assess patient response at follow-up (data not shown) we could determine if the effect was permanent and if there were adverse effects that could limit the ability to assess long-term follow-up. Our analysis on overall response is based a limited number of patients. Secondly, the study was not a randomized controlled trial. Patients to the imitrexate and cetuximab combination had similar baseline rates of disease progression but the imitrexate group did benefit more from the combination. This could be because of the high number baseline imitrexate and cetuximab users compared to the low number of baseline imitrexate and cetuximab non-users in our study, or because imitrexate was more effective at delaying disease progression in the imitrexate group (6), which in turn led to more benefit from the combination (6). These data should be interpreted cautiously given these limitations. A final limitation is that this was a single site, observational study. Although we used standard criteria for assessing long-term response to imitrexate and cetuximab for patients with advanced CFS and CFS/ME, our study is not the first attempt to assess that outcome. In a large trial of imitrexate treatment, the median duration to first disease progression was about 5 months (20).

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