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Enbrel vs Humira
Introduction
For patients with autoimmune diseases such as rheumatoid arthritis, psoriatic arthritis or ankylosing spondylitis, certain drugs that alter the immune system's responses can help in managing symptoms and slow disease progression. Enbrel and Humira are two such drugs prescribed for these conditions. Both medications work by targeting specific proteins in your body’s immune system to prevent inflammation that can lead to damage in joints and skin cells.
Enbrel (etanercept) is a tumor necrosis factor (TNF) blocker, which works by binding to TNF molecules and stopping them from attaching to and activating TNF receptors on the cell surface. This prevents the inflammatory response of auto-immune disorders.
Humira (adalimumab), on the other hand, is a monoclonal antibody – it attaches itself directly to TNF-alpha, blocking its interaction with cell-surface TNF receptors thus reducing inflammation.
What is Enbrel?
Etanercept (the generic name for Enbrel) was one of the first drugs of the TNF inhibitor class used to manage autoimmune diseases. Etanercept was approved by the FDA in 1998, marking a significant development from traditional immunosuppressive medications. Enbrel works by binding to tumor necrosis factor-alpha (TNF-alpha), effectively "trapping" it and preventing it from promoting inflammation within the body. It is prescribed for conditions like rheumatoid arthritis, psoriasis, and ankylosing spondylitis. Compared to Adalimumab (Humira), another TNF inhibitor, Etanercept has a more selective action as it only binds to TNF-alpha but not other pro-inflammatory cytokines such as interleukin-1 and -6. This results in fewer side effects than Humira that targets these other cytokines too.
What conditions is Enbrel approved to treat?
Enbrel is approved for the treatment of various autoimmune disorders, including:
- Rheumatoid arthritis
- Psoriatic arthritis
- Plaque psoriasis
- Ankylosing spondylitis
- Juvenile idiopathic arthritis (for patients aged 2 years and older)
Some of these conditions may also be treated with another biologic agent, Humira.
How does Enbrel help with these illnesses?
Enbrel works to manage autoimmune diseases by inhibiting the action of tumor necrosis factor (TNF), a protein that plays a significant role in inflammation and immune response. It does this by acting as a decoy receptor for TNF, effectively binding to it and preventing it from interacting with its natural receptors, thereby reducing inflammation. Autoimmune conditions like rheumatoid arthritis, psoriatic arthritis, or plaque psoriasis are characterized by an overactive immune system that mistakenly attacks healthy cells leading to chronic inflammation. With Enbrel's ability to block TNF, the drug can alleviate some of the symptoms associated with these conditions such as joint pain or skin plaques and help patients manage their condition more effectively.
What is Humira?
Humira, with its generic name adalimumab, is a TNF (tumor necrosis factor) inhibitor. It works by blocking the activity of TNF-alpha—an inflammatory substance in the body—thus reducing inflammation and slowing disease progression. This medication was first approved by the FDA in 2002. Unlike Enbrel which acts upon two types of TNF molecules, Humira specifically targets TNF-alpha, potentially offering more precision in treatment. Its distinct mode of action means that its side-effect profile is different from that of other drugs such as Enbrel; for instance, it may cause fewer injection site reactions but can increase susceptibility to certain infections due to its immunosuppressive nature. The effects on inflammation can be beneficial for treating various autoimmune diseases like rheumatoid arthritis or Crohn's disease particularly in patients who do not respond well to typical drugs like Enbrel.
What conditions is Humira approved to treat?
Humira has been given the green light by the Food and Drug Administration for treating a range of conditions in the US, including:
- Rheumatoid arthritis
- Psoriatic arthritis
- Ankylosing spondylitis
- Crohn's Disease
- Ulcerative colitis
- Plaque psoriasis
How does Humira help with these illnesses?
Tumor necrosis factor (TNF) is a cell signaling protein involved in systemic inflammation and one of the cytokines that make up the acute phase reaction. It's overproduction has been implicated in a variety of diseases such as rheumatoid arthritis, psoriasis, and inflammatory bowel disease. Humira works by inhibiting TNF, thereby reducing the inflammatory response associated with these conditions. Its action on both soluble and transmembrane TNF may also play roles in its effectiveness against autoimmune disorders like rheumatoid arthritis or Crohn's disease. Since it acts specifically on TNF, it is often prescribed when a patient does not respond well to other medications or treatments targeting different pathways (such as Enbrel), or may be combined with them for more effective treatment.
How effective are both Enbrel and Humira?
Both etanercept (Enbrel) and adalimumab (Humira) are widely used in the treatment of various autoimmune diseases, including rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis. Etanercept was approved by the FDA in 1998 while adalimumab received its approval a few years later in 2002. These drugs share a similar mechanism of action as they both inhibit tumor necrosis factor-alpha (TNF-α), albeit through slightly different methods; etanercept is a TNF receptor fusion protein while adalimumab is a monoclonal antibody against TNF-α.
In terms of effectiveness, both Enbrel and Humira have demonstrated strong efficacy for reducing symptoms of inflammation-associated conditions such as pain, swelling, stiffness and preventing joint damage across numerous clinical trials. Although individual patient responses may vary due to factors like genetics or disease severity.
A systematic review conducted in 2016 indicated that Enbrel significantly improved symptoms related to rheumatoid arthritis starting from the first week of treatment with minimal side effects such as injection site reactions and infections. Furthermore, it has also been reported to be well-tolerated among individuals across various age groups which makes it one of the commonly prescribed biologics worldwide for treating inflammatory diseases.
On the other hand, studies show that Humira seems comparable to Enbrel regarding its ability to manage autoimmune disorders effectively when used alone or alongside methotrexate – another standard drug for these conditions. However, Humira might cause more serious adverse events like severe infections compared to Enbrel even though such occurrences are relatively rare. Additionally due because it targets TNF specifically rather than broadly blocking cytokines like some other treatments do – this specificity means that patients who failed on previous therapies might respond better with Humira.
At what dose is Enbrel typically prescribed?
Dosages of Enbrel typically range from 25-50 mg per week, administered via subcutaneous injection. For most adults with moderate to severe rheumatoid arthritis, the recommended dose is 50 mg per week. Pediatric patients with juvenile idiopathic arthritis usually start on a weekly dose based on their weight. If there's no response after several weeks, your healthcare provider may consider adjusting the dosage or switching to another medication. It's important not to exceed the maximum dosage prescribed by your doctor.
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At what dose is Humira typically prescribed?
Humira treatment usually begins with a loading dose of 160 mg on Day 1 (given as four 40 mg injections in one day or two 40 mg injections per day for two consecutive days). Following this, the dosage shifts to 80 mg every other week starting one week after the initial dose. Depending on its effectiveness and individual patient tolerance, the dosage can be adjusted to as much as 40-80mg every week or spaced further apart if necessary. However, it's worth noting that patients should always consult their doctor before making any adjustments themselves; personalizing your Humira regimen depends heavily on factors like your specific condition being treated, how well you respond to therapy initially and over time, and overall health status.
What are the most common side effects for Enbrel?
Potential side effects of Enbrel and Humira can include:
- Headache
- Dizziness, faintness
- Nausea, vomiting
- Abdominal discomfort or pain (dyspepsia)
- Diarrhea
- Skin rashes, itching
- Redness or swelling at the injection site
- Respiratory infections (like sinusitis)
- Fatigue, general weakness (asthenia)
- Fever-like symptoms (flu syndrome)
More serious side effects might involve:
- More frequent infections due to a weakened immune system,
- Unusual bleeding or bruising,
- Chest pain,
- Shortness of breath,
- Swelling in ankles and feet.
Always consult with your healthcare provider if you experience any unusual symptoms while on these medications.
Are there any potential serious side effects for Enbrel?
While both Enbrel and Humira are usually well-tolerated, they can cause serious side effects in some patients. Be aware of the following potential signs when taking these medications:
- Unusual changes in mood or behavior, such as increased thoughts about self-harm
- Signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat
- Vision problems like blurred vision or eye pain
- Heart issues such as palpitations, chest fluttering sensation, shortness of breath and sudden dizziness
- Symptoms related to low sodium levels - headache, confusion, slurred speech severe weakness vomiting loss coordination feeling unsteady
- Muscle stiffness (rigid muscles), high fever sweating confusion fast uneven heartbeats tremors feeling you might pass out indicating a possible severe nervous system reaction
- Symptoms indicative of any autoimmune reactions: muscle pain or weakness rash on cheeks nose that worsens sunlight joint pain swollen glands
If you experience any of these symptoms while taking Enbrel or Humira seek immediate medical attention.
What are the most common side effects for Humira?
Humira, like any other medication, can cause a range of side effects. Some people may experience:
- Redness, itching or bruising at the injection site
- Headache
- Rash
- Upper respiratory infections such as sinus infection and sore throat
- Nausea and stomach pain.
More severe but less common side effects include nervous system problems (like multiple sclerosis), blood disorders, liver problems, heart failure, immune reactions (like a lupus-like syndrome), psoriasis and allergic reactions. It's also important to be aware that Humira can make you more susceptible to infections because it weakens your immune system. Always consult with your healthcare provider for personalized advice before starting new medication regimes.
Are there any potential serious side effects for Humira?
While Humira can be highly beneficial for managing symptoms of autoimmune conditions, it's important to note that it may sometimes cause serious side effects. These include:
- Signs of an allergic reaction such as difficulty breathing; swelling of your face, lips, tongue or throat
- Skin reactions like itching, rash or redness where the injection was given
- Symptoms related to nervous system problems: numbness or tingling sensations; weakness in your legs; vision changes
- Heart failure symptoms including shortness of breath with exertion or while lying down; swelling in your ankles and feet; sudden weight gain from fluid retention
- Liver problems - nausea/vomiting that won't stop, loss of appetite, pain on the right side of your abdomen (belly area), dark urine ("tea-colored"), yellowing skin/eyes (jaundice)
If you experience any such signs after starting Humira treatment, seek immediate medical advice.
Contraindications for Enbrel and Humira?
Both Enbrel and Humira, along with most other immunosuppressant medications, may worsen symptoms of infections in some people. If you notice your infection worsening, or an increase in fever, pain, or swelling at the injection site, please seek immediate medical attention.
Neither Enbrel nor Humira can be taken if you are taking certain antiviral drugs such as ritonavir or cobicistat. Always tell your physician which medications you are taking; these antiviral drugs might interact with Enbrel and Humira causing potential adverse effects. Furthermore, both medications should not be used by patients who have been diagnosed with multiple sclerosis due to their potential for exacerbating neurological conditions.
How much do Enbrel and Humira cost?
For the brand name versions of these drugs:
- The price for four single-use prefilled syringes of Enbrel (50 mg each) averages around $5,500, which works out to about $343.75 per week or approximately $49/day.
- The price for two pens of Humira (40 mg each) is on average about $5,600 working out to roughly $350 per week or approximately $50/day.
Thus, while there is a small difference in cost between these two medications if you are considering their weekly expense, it's worth noting that this difference may not be significant enough to justify choosing one over the other based solely on price.
There aren't any generic versions available for either Enbrel (etanercept) or Humira (adalimumab), so costs remain high across the board. However, both manufacturers offer patient assistance programs that can help reduce costs significantly depending upon eligibility criteria and insurance coverage. As always though, cost should not be your primary consideration when determining which medication is best suited to your needs.
Popularity of Enbrel and Humira
In the biologic medication class, Enbrel and Humira are two of the most widely prescribed treatments for autoimmune diseases in the United States.
Enbrel, also known as etanercept, was estimated to have been administered to about 1 million people in the US in 2020. It accounts for roughly 15% of all prescriptions for TNF inhibitors (a category of drugs used to reduce inflammation). Enbrel has seen an increase in usage since its approval by FDA in 1998.
Adalimumab, commonly recognized by its brand name Humira, had a patient population nearing 800 thousand people within the same time frame. In terms of prescriptions written for TNF inhibitors within the USA, adalimumab holds a market share just under that of Enbrel at approximately 14%. Despite entering the market later than Enbrel (FDA approved it in late-2002), Humira has managed to establish itself as a strong competitor due to its efficacy across multiple autoimmune disorders such as rheumatoid arthritis and psoriasis.
Conclusion
Both Enbrel (etanercept) and Humira (adalimumab) have a solid track record of treating autoimmune diseases such as rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, and plaque psoriasis. They are backed by numerous clinical trials demonstrating efficacy superior to placebo treatments. Occasionally these medications can be used in combination with other disease-modifying antirheumatic drugs (DMARDs), but this depends on careful evaluation by a physician due to potential increased risk for serious infections.
Enbrel and Humira function differently: Enbrel inhibits tumor necrosis factor (TNF), a protein that contributes to inflammatory responses, while Humira binds specifically to TNF-alpha, blocking its interaction with cell surface receptors. These differences may lead doctors to prefer one over the other based on individual patient needs.
Both biologics are available in biosimilar form offering cost savings especially for patients who must pay out of pocket. It may take several weeks before the full effects of both Enbrel and Humira become noticeable.
The side effect profiles of both drugs are similar; they're generally well-tolerated but carry risks like serious infections or malignancies due to their immunosuppressive nature. Patients should closely monitor their health status when starting treatment and seek immediate medical help if they notice symptoms like persistent fever or unexplained weight loss.