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Enbrel vs Simponi
Introduction
For patients with autoimmune disorders such as rheumatoid arthritis, psoriatic arthritis or ankylosing spondylitis, certain medications that influence the immune response can help manage symptoms and prevent disease progression. Enbrel and Simponi are two such drugs often prescribed to treat these conditions. Both medicines work by blocking a protein made by your body's immune system called tumor necrosis factor (TNF), which is associated with inflammation.
Enbrel (etanercept) binds to TNF molecules in your bloodstream before they can attach to other cells and cause inflammation. On the other hand, Simponi (golimumab) works slightly differently; it inhibits TNF directly at the site of inflammation. While both have been found effective in reducing symptoms and slowing down disease progression, factors like individual patient medical history, lifestyle considerations and cost may influence whether one is prescribed over the other.
What is Enbrel?
Etanercept (the generic name for Enbrel) was one of the first drugs of the biologic class, which marked a significant advancement over earlier medications used to treat autoimmune diseases. Etanercept was approved by the FDA in 1998 and is used to reduce inflammation and stop disease progression in conditions such as rheumatoid arthritis. It works by blocking tumor necrosis factor alpha (TNF alpha), a soluble inflammatory cytokine, from interacting with its receptors on cell surfaces, effectively "trapping" it so that it cannot continue promoting inflammation within the body.
Golimumab (the generic name for Simponi) is another TNF inhibitor but came onto the market later than Enbrel; it received FDA approval in 2009. Like Enbrel, Simponi also reduces inflammation and slows down disease progression but has been engineered to last longer in your system. This means patients may require fewer doses compared to those taking Enbrel.
Both medications carry risk factors including serious infections and cancers due to their immunosuppressive nature. However, they differ slightly in terms of side effects and dosing schedules making them more suitable for different patient populations based on individual health considerations.
What conditions is Enbrel approved to treat?
Enbrel is approved for the treatment of several autoimmune disorders, including:
- Rheumatoid arthritis (for adults and children 2 years or older)
- Juvenile idiopathic arthritis (for patients aged 2 years or above)
- Psoriatic arthritis
- Ankylosing spondylitis
- Plaque psoriasis in patients who are candidates for systemic therapy or phototherapy.
How does Enbrel help with these illnesses?
Enbrel helps to manage autoimmune conditions by inhibiting the activity of tumor necrosis factor (TNF), a protein in the body that plays a key role in promoting inflammation and immune responses. It does this by acting as a decoy receptor, binding to TNF before it can interact with its natural receptors on cells, thus reducing the inflammatory response. TNF is an important player in various biological processes, including cell proliferation, differentiation, apoptosis and immune regulation among other things. In individuals with certain autoimmune diseases like rheumatoid arthritis or psoriasis, there are higher levels of TNF which contribute to excessive inflammation damaging tissues. Therefore, by reducing TNF's ability to promote inflammation through its blocking action, Enbrel can limit the negative effects of these disorders and help patients manage their condition more effectively.
What is Simponi?
Simponi, also known as golimumab, is a human monoclonal antibody that inhibits tumor necrosis factor alpha (TNF-alpha), a protein that plays a crucial role in inflammatory processes of the body. By blocking TNF-alpha, Simponi can reduce inflammation and halt disease progression in conditions like rheumatoid arthritis, psoriatic arthritis and ankylosing spondylitis. This drug was first approved by the FDA in 2009.
As Simponi is not an etanercept-based therapy like Enbrel, it does not interact with two different types of cytokines: lymphotoxin alpha and TNF-beta. Its specific action on TNF-alpha means its side-effect profile may differ from those of drugs like Enbrel; for example, it does not cause reactions at the injection site as frequently or lead to certain infections as often. The effects on controlling inflammation can be beneficial for patients who do not respond well to typical anti-TNF drugs such as Enbrel.
What conditions is Simponi approved to treat?
Simponi, also known by its generic name Golimumab, is FDA-approved for the treatment of several chronic inflammatory conditions such as:
- Rheumatoid arthritis (RA), which causes inflammation in joints leading to pain and stiffness
- Psoriatic arthritis (PA), a type of inflammatory arthritis affecting some people with psoriasis
- Ankylosing spondylitis (AS), a form of spinal arthritis that can cause back pain and stiffness.
It's essential to note Simponi is usually prescribed when other medications or treatments haven't worked effectively.
How does Simponi help with these illnesses?
Tumor necrosis factor (TNF) is a powerful protein involved in systemic inflammation, playing a crucial role in the development and progression of autoimmune diseases like rheumatoid arthritis and psoriatic arthritis. Simponi works by targeting and neutralizing TNF, thereby reducing inflammation and other symptoms associated with these conditions. The action of Simponi on TNF also contributes to its effectiveness as an immunosuppressant. Unlike Enbrel, which needs to be administered weekly, Simponi's longer half-life allows for less frequent dosing - typically once a month - providing convenience for patients. Therefore, it may be preferred over Enbrel when less frequent administration is beneficial or necessary due to patient lifestyle or compliance issues.
How effective are both Enbrel and Simponi?
Both etanercept (Enbrel) and golimumab (Simponi) are successful biologics in treating autoimmune diseases such as rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis. They were approved by the FDA within a decade of each other, with Enbrel being older than Simponi. Both drugs act by inhibiting tumor necrosis factor-alpha (TNFα), but they do so in different ways: Enbrel is a fusion protein specifically designed to capture TNFα before it can interact with cell surface receptors to provoke inflammation; Simponi is an antibody that binds directly to TNFα.
A 2010 clinical trial comparing several anti-TNF therapies found both Enbrel and Simponi effective at reducing symptoms of rheumatoid arthritis, showing similar safety profiles[1]. It's worth noting that neither drug "cures" any disease state; rather, they manage symptoms effectively when taken consistently.
The Cochrane Database performed a meta-analysis on randomized trials involving anti-TNF treatments for rheumatoid arthritis through 2009. The review concluded that etanercept was generally well-tolerated and reduced disease activity notably within two weeks of treatment commencement [2]. Its side effect profile compared favorably against other classes of medication for RA.
Golimumab has also demonstrated efficacy according to another systematic review published in 2017 [3]. While typically used after methotrexate or other first-line treatments have failed, it might be considered sooner due to its convenience - it requires less frequent dosing than some alternatives. However, evidence confirming its efficacy as monotherapy isn't quite as robust as that supporting combination therapy with methotrexate or another DMARD. Nonetheless, golimumab may offer advantages over other TNF inhibitors due to its monthly administration schedule and autoinjector device option.
[1] https://pubmed.ncbi.nlm.nih.gov/20804577/ [2] https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD008143.pub2/full [3] https://link.springer.com/article/10.1007/s40263-017-0416-x
At what dose is Enbrel typically prescribed?
Subcutaneous dosages of Enbrel for adults typically start at 50 mg per week, which has been shown to be effective in treating rheumatoid arthritis and other inflammatory conditions. Adolescents aged 12-17 may also follow this dosage if they have chronic moderate-to-severe plaque psoriasis. Dosage adjustments can be made after a few weeks depending on the patient's response; occasionally, it might need to be increased for certain individuals. For Simponi, subcutaneous doses are generally given once a month at 50mg for most indications, but like with Enbrel treatments, the dose could be adjusted based on individual responses or specific medical conditions such as ulcerative colitis where higher doses may initially be required. It is important not to exceed recommended dosages without consulting your healthcare provider.
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At what dose is Simponi typically prescribed?
Simponi treatment is usually initiated with a dosage of 50 mg once per month. This dose can be administered under the skin (subcutaneously) and should preferably be done on the same day each month for consistency. If there's an inadequate response to this initial dosage, your healthcare provider might consider adjusting or changing your medication regimen accordingly. However, exceeding the recommended monthly dose of 50 mg isn't generally advisable as it could increase the potential risk for adverse effects without necessarily enhancing therapeutic benefits. Always follow your doctor’s instructions when taking Simponi or any similar medications.
What are the most common side effects for Enbrel?
Potential side effects of Enbrel and Simponi can include:
- Infections (such as upper respiratory or sinus infections)
- Injection site reactions (redness, itching, pain)
- Headache
- Dizziness
- Nausea and/or diarrhea
- Muscle or joint pain
- Changes in blood pressure -Rash or skin conditions -Fever and fatigue
These medications are strong immune suppressors; therefore they may increase the risk for serious infections. If you notice any signs of infection while taking these drugs such as fever, sweats, tiredness or cough with mucus, seek medical attention immediately. It's also important to inform your healthcare provider if you've had tuberculosis before starting treatment.
Are there any potential serious side effects for Enbrel?
While both Enbrel and Simponi are used to treat similar conditions, they can have different side effects. For Simponi, be aware of potentially serious side effects such as:
- Signs of an allergic reaction: hives; difficulty breathing; swelling in your face or throat.
- Symptoms indicating a possible infection: fever, sweating, chills, muscle aches; cough with mucus or blood; sores on your skin that won't heal; burning when you urinate.
- Liver problems: nausea/vomiting that doesn't stop, loss of appetite, stomach pain on the upper right side, yellowing eyes/skin (jaundice), dark urine.
- Nervous system issues: numbness/tingling sensation in any part of your body; weakness in legs or arms leading to sudden falls; vision changes.
With Enbrel usage:
- Look out for potential infection symptoms like persistent sore throat/cough/fever/chills.
- Nerve disorders might occur. These include unsteadiness and arm/leg/hand tingling/numbness/burning/pain Watch for signs hinting at heart failure like unusual tiredness/swelling ankles and feet/unexplained sudden weight gain.
If you experience any severe symptoms after taking either medication mentioned above - seek immediate medical attention.
What are the most common side effects for Simponi?
Specific side effects related to Simponi can include:
- Upper respiratory infections like sore throat and stuffy nose
- Redness, itching or reactions at the injection site
- Nausea, stomach pain, constipation
- Headache, dizziness
- High blood pressure (potentially causing a fast heartbeat)
- Elevated liver enzymes which may indicate inflammation or damage to cells in the liver
- Rash It's also worth noting that some people using Simponi have reported experiencing serious nervous system problems such as seizures and multiple sclerosis. Always consult your healthcare provider for advice on medication choices and potential side effects.
Are there any potential serious side effects for Simponi?
While Simponi is a highly effective medication for diseases such as rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis and ulcerative colitis, it can also cause several serious side effects in rare instances. If you are taking Simponi and notice any of the following symptoms, seek immediate medical attention:
- Signs of allergic reaction: hives; difficulty breathing; swelling in your face or throat
- Symptoms related to infections: fever, sweating, chills, muscle aches
- Skin reactions: redness where the medicine was injected; bruising or bleeding easily
- Neurological problems like numbness or tingling; vision problems; dizziness
- Liver issues indicated by yellowing skin and eyes (jaundice), dark urine.
Remember that although these symptoms can be alarming they are quite rare. Nonetheless if you experience them while on Simponi treatment please consult with your healthcare provider immediately.
Contraindications for Enbrel and Simponi?
Both Enbrel and Simponi, as with most other biologic medications, may worsen symptoms of infection in some people. If you notice your symptoms worsening or begin experiencing rapid weight loss, fatigue, night sweats or persistent fever, seek immediate medical attention.
Neither Enbrel nor Simponi should be taken if you are suffering from tuberculosis (TB), have been recently treated for TB or have travelled to areas where TB is common. Always tell your physician which medications you are taking; anti-TB medicines will require a period of about 4 weeks to clear from the system to prevent dangerous interactions with Enbrel and Simponi.
These two drugs can also exacerbate Hepatitis b infections in carriers of this virus. Before starting treatment with either drug, patients must be tested for Hepatitis B due to potential reactivation during therapy.
Additionally while using these treatments it's important to get regular check-ups as they may cause liver problems such as Hepatitis B reactivation in chronic carriers of the virus.
How much do Enbrel and Simponi cost?
For the brand name versions of these drugs:
- The price of one single-dose prefilled syringe or autoinjector pen of Enbrel (50 mg) averages around $1,400, which is typically administered once weekly. This works out to approximately $200/day if taken daily.
- The cost for a single-dose pre-filled syringe or auto-injector pen of Simponi (50 mg) is about $2,800 on average. Given that Simponi is usually injected once a month, this roughly equates to about $93/day.
Thus, if you compare the daily costs based on typical dosages and frequency of administration, then brand-name Simponi appears less expensive than Enbrel. However, it's crucial to note that cost should not be your primary consideration when determining which drug is right for you.
As with most biologic medications used in treating rheumatoid arthritis and other autoimmune diseases like psoriasis or inflammatory bowel disease (Crohn’s disease and ulcerative colitis), there are currently no generic versions available for either Enbrel (etanercept) or Simponi (golimumab).
Popularity of Enbrel and Simponi
Etanercept, also known by its brand name Enbrel, and Golimumab, known as Simponi, are both popular choices for the treatment of autoimmune diseases such as rheumatoid arthritis.
In 2020, approximately 1.6 million prescriptions were written for Enbrel in the United States. This accounted for roughly 20% of all prescriptions given to patients with autoimmune diseases that year. Etanercept has been on the market since the late '90s and its use among patients with these conditions has remained stable over time.
Simponi is less widely used than Enbrel but still holds a significant place in treating autoimmune disorders. In 2020, it was estimated that around half a million prescriptions were filled for Simponi in the US. Despite having been approved more recently than etanercept (in early 2009), golimumab's prescription numbers have steadily increased each year since then due to its monthly dosing schedule which offers convenience over other options requiring weekly injections.
Conclusion
Both Enbrel (etanercept) and Simponi (golimumab) have long-standing records of usage in patients with rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, and other inflammatory conditions. They are supported by numerous clinical studies indicating their effectiveness compared to placebo treatments. These two drugs work by blocking the action of tumor necrosis factor-alpha (TNF-α), a protein that contributes to inflammation.
Enbrel has been on the market longer than Simponi and is often considered as a first-line treatment option for many inflammatory diseases. On the other hand, Simponi might be chosen if a patient does not respond well to Enbrel or other TNF inhibitors or prefers less frequent dosing schedules - it's administered once monthly compared to Enbrel which is usually taken once weekly.
While both medications are available in generic form offering cost savings especially for patients who must pay out-of-pocket, they can still be quite expensive due to being biologics.
The side effect profiles are similar between these two medications; however, each individual may experience them differently. Common side effects include injection site reactions, upper respiratory infections, headache, and nausea. Due to the nature of these drugs suppressing the immune system in order to reduce inflammation there's also an increased risk of serious infections so any sign of infection should immediately be reported your doctor.