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Olumiant vs Xeljanz
Introduction
For patients with rheumatoid arthritis or other types of inflammatory diseases, certain drugs that alter the immune response can help manage symptoms and slow disease progression. Olumiant and Xeljanz are two such drugs that are often prescribed for these conditions. Each impacts different pathways in the immune system but both have anti-inflammatory effects in patients with autoimmune disorders. Olumiant (Baricitinib) works by blocking enzymes known as Janus kinases which play a crucial role in the inflammation process while Xeljanz (Tofacitinib) also targets Janus kinases, albeit differently, leading to reduced inflammation and pain relief for those suffering from conditions like rheumatoid arthritis.
What is Olumiant?
Baricitinib (the generic name for Olumiant) is a Janus kinase inhibitor, a new class of drugs that represents significant progress from the first generation of disease-modifying antirheumatic drugs (DMARDs). Baricitinib was first approved by the FDA in 2018. Olumiant works by blocking certain enzymes in the body that affect immune system function, thereby reducing inflammation and other symptoms associated with autoimmune diseases like rheumatoid arthritis. It has an emphasis on inhibiting JAK1 and JAK2 enzymes with less effect on JAK3 and TYK2, which results in it having fewer side effects than other DMARDs such as Tofacitinib (Xeljanz), which affects all four types of these enzymes more equally.
What conditions is Olumiant approved to treat?
Olumiant is approved for the treatment of several autoimmune conditions:
- Moderate to severe rheumatoid arthritis in adults who have had an inadequate response to one or more tumor necrosis factor (TNF) antagonist therapies
- Active psoriatic arthritis in adults, used alone or with methotrexate
- Ankylosing spondylitis in adults who have not responded well enough to nonsteroidal anti-inflammatory drugs (NSAIDs).
In comparison, Xeljanz is also approved for similar types of autoimmune diseases:
- Moderate to severe rheumatoid arthritis
- Psoriatic Arthritis
- Ulcerative colitis It should be noted that both medications require a prescription and should only be taken under the supervision of a healthcare provider.
How does Olumiant help with these illnesses?
Olumiant, like Xeljanz, is a medication used to manage rheumatoid arthritis by decreasing the activity of the immune system. This happens by inhibiting an enzyme called Janus kinase (JAK), thus reducing inflammation and other symptoms associated with autoimmune disorders like rheumatoid arthritis. By blocking JAK enzymes, these medications interfere with the JAK-STAT signaling pathway that plays a critical role in the immune response. When this pathway is overactive, it can lead to excessive immune responses and inflammation seen in conditions such as rheumatoid arthritis. Therefore, by inhibiting this pathway using medications such as Olumiant or Xeljanz, patients can better manage their condition and reduce their symptoms.
What is Xeljanz?
Xeljanz, with the generic name tofacitinib, is a Janus kinase inhibitor that works by blocking the effect of certain enzymes in your body that can affect your immune system. It was initially approved by the FDA in 2012 for its use in treating rheumatoid arthritis and has since gained approval for treatment of psoriatic arthritis and ulcerative colitis as well. As it's not a conventional DMARD (Disease-Modifying Antirheumatic Drug), like methotrexate or hydroxychloroquine, it does not work by suppressing your entire immune response but rather targets specific pathways of inflammation. This selective action means that its side-effects profile also differs from typical DMARDs; it does not cause nausea or hair loss but can lead to more serious issues such as severe infections due to lowered immunity. The effects on these inflammatory pathways make Xeljanz beneficial especially for patients who don't respond well or have intolerable side effects with "typical" DMARDs.
What conditions is Xeljanz approved to treat?
Xeljanz is a medication that has received approval from the FDA for use in treating several conditions, including:
- Moderate to severe rheumatoid arthritis
- Active psoriatic arthritis
- Moderate to severe ulcerative colitis This makes Xeljanz a versatile option for patients dealing with these specific immune-related health issues.
How does Xeljanz help with these illnesses?
Janus kinases (JAKs) are proteins that play a significant role in inflammatory processes within the body, particularly those associated with rheumatoid arthritis. Xeljanz functions by inhibiting these JAKs, consequently reducing inflammation and easing symptoms of arthritis such as pain, swelling, and stiffness. As well as its action on JAK1 and 3 similar to Olumiant, it also impacts JAK2 - this broader spectrum potentially allows for more comprehensive symptom control. However, like all immunosuppressive drugs it carries risks including serious infections and malignancies; hence its use is typically reserved for patients who have not responded well to methotrexate or other disease-modifying antirheumatic drugs (DMARDs). Its unique mechanism may make it an effective option when combined with these DMARDs or used alone in specific cases.
How effective are both Olumiant and Xeljanz?
Baricitinib (Olumiant) and tofacitinib (Xeljanz) are both oral Janus kinase inhibitors that target JAK pathways involved in the pathogenesis of rheumatoid arthritis. They were approved by the FDA within five years of each other, with Xeljanz earning approval first in 2012 followed by Olumiant in 2017. As they have similar mechanisms of action but differ slightly on their selectivity for specific JAK enzymes, they may be employed under different clinical scenarios.
The efficacy of both drugs was directly compared in a randomized controlled trial published in 2021; both exhibited comparable effectiveness at reducing symptoms and slowing disease progression while presenting acceptable safety profiles.[1] No significant differences were noted between patients receiving either drug regarding primary endpoints such as ACR20 response rates or changes from baseline Disease Activity Score-28.
A comprehensive review from 2020 highlighted that baricitinib generally starts showing its anti-inflammatory effects swiftly after starting therapy, usually within one week. It is well-tolerated and has a manageable side effect profile similar to many other disease-modifying antirheumatic drugs (DMARDs). The recommended daily dose for optimal benefit is typically 4 mg once daily, although lower doses can also provide substantial relief for some patients.[2]
On the other hand, tofacitinib's therapeutic benefits were confirmed through several placebo-controlled trials indicating it's more effective than placebo at alleviating symptoms of moderate-to-severe rheumatoid arthritis[3]. Although it is often considered an alternative or add-on option when conventional DMARDs fail due to its unique mechanism, it holds promise as monotherapy too. However, further research confirming its standalone efficacy against traditional DMARDs would strengthen this proposition.
Both medications have been associated with certain risks including serious infections and malignancies; hence caution must be exercised especially among those prone to these conditions[4].
Sources: [1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7989648/ [2] https://pubmed.ncbi.nlm.nih.gov/31428954/ [3] https://onlinelibrary.wiley.com/doi/full/10.1002/art.39463 [4]https://www.accessdata.fda.gov/drugsatfda_docs/appletter/2020/205832Orig1s011ltr.pdf
At what dose is Olumiant typically prescribed?
Oral dosages of Olumiant are typically 2 mg once daily, although some patients may be prescribed a lower dose based on their doctor's recommendations. For Xeljanz, the standard dosage is usually 5 mg twice daily for rheumatoid arthritis and psoriatic arthritis patients. Dosage can be adjusted after a few weeks if there is no response or in case of adverse reactions. It’s important to note that the maximum advised dosage for Olumiant should not exceed 4 mg per day, while for Xeljanz it should not surpass 10 mg taken twice daily under any circumstances. Always consult your healthcare provider before starting or altering your medication regimen.
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At what dose is Xeljanz typically prescribed?
Xeljanz treatment is usually initiated at a dosage of 5 mg twice daily. The dose can then be adjusted based on the individual's response and tolerability. However, some patients with certain conditions like kidney or liver disease may require a lower starting dose. A daily maximum dose of 11 mg (one 11-mg extended-release tablet) can also be considered in individuals who do not show adequate response to the initial regimen after careful consideration of potential benefits and risks. It's important to note that Xeljanz should always be taken as instructed by a healthcare professional, as it carries various considerations regarding its use and potential side effects.
What are the most common side effects for Olumiant?
Common side effects of Olumiant may include:
- Upper respiratory tract infections
- Nausea
- Herpes simplex (cold sores and genital herpes)
- Herpes zoster (shingles)
- Increased cholesterol levels
- Abnormal liver function tests
On the other hand, common side effects of Xeljanz can include:
- Upper respiratory tract infections
- Diarrhea
- Nasopharyngitis (common cold)
-Nausea
-High blood pressure
-Zoster (shingles)
While both medications have similar potential for upper respiratory tract infections and nausea, each has unique potential side effects that should be considered. Always consult with a healthcare provider to determine what medication is best for you based on your medical history and current health status.
Are there any potential serious side effects for Olumiant?
While both Olumiant and Xeljanz are used to treat rheumatoid arthritis, they can have potentially serious side effects. For Olumiant, these may include:
- Signs of tuberculosis infection: persistent cough, weight loss, night sweats
- Symptoms of potential blood clots: chest pain or pressure, shortness of breath, swelling or warmth in the leg
- Severe stomach pain (especially on your right), vomiting, loss of appetite - symptoms that could suggest a liver problem
- Low neutrophil levels causing fever and other signs of infection
With Xeljanz you should be aware of:
- Signs pointing to an allergic reaction such as hives; difficulty breathing; swelling in face or throat
- Vision changes suggesting nerve problems: blurred vision, sensitivity to light
- Rapid heart rate leading to fluttering in your chest
- Unusual bleeding or bruising linked with low platelet counts -Infections brought about by low lymphocyte count evident via feverish chills and flu-like symptoms
If any adverse reactions occur while taking either medication it's important that medical attention is sought immediately.
What are the most common side effects for Xeljanz?
When considering Xeljanz, potential side effects may include:
- Upper respiratory tract infections, stuffy or runny nose
- Nausea, vomiting, stomach pain
- Diarrhea and other digestive issues
- Headache and dizziness
- High blood pressure (hypertension)
- Increased cholesterol levels
- Coughing and breathing difficulties
- Rash or skin irritations
- Fatigue or feeling unwell (malaise) These side effects are not definitive but rather possibilities. Always consult with your healthcare professional before starting a new medication.
Are there any potential serious side effects for Xeljanz?
Xeljanz, like any medicine, can have potential side effects. Some of these could indicate a severe reaction and require immediate attention from your healthcare provider:
- Signs of an allergic reaction: hives; difficulty breathing; swelling in your face or throat
- Serious skin reactions: fever, sore throat, burning eyes, skin pain with a red or purple rash that spreads and causes blistering and peeling
- Changes in mood or mental state: confusion, memory problems or unusual changes in mood or behavior
- Vision issues: blurred vision, tunnel vision
- Heart problems signs: fast heartbeats/ irregular heartbeat
Remember to report these symptoms immediately if you experience them while on Xeljanz.
Contraindications for Olumiant and Xeljanz?
Both Xeljanz and Olumiant, as with most Rheumatoid arthritis (RA) medications, may exacerbate symptoms of infections. If you notice an increase in symptoms such as fever, cough or flu-like signs, please seek immediate medical attention.
Neither Xeljanz nor Olumiant can be taken if you are taking or have recently taken certain other drugs like biologic disease-modifying antirheumatic drugs (DMARDs). Always inform your physician about any medications you are currently on; these DMARDs will require a proper washout period to prevent dangerous interactions with both Xeljanz and Olumiant.
It's also noteworthy that both these medications could possibly increase the risk of blood clots leading to serious conditions like deep vein thrombosis (DVT) or pulmonary embolism. Therefore it is crucial for patients who smoke or have a history of heart disease to disclose this information before starting therapy.
How much do Olumiant and Xeljanz cost?
For the brand name versions of these drugs:
- The price of 30 tablets of Olumiant (2 mg) averages around $3,000, which works out to approximately $100/day.
- The cost for a monthly supply (60 tablets) of Xeljanz XR (11mg) is about $5,400, working out to roughly $180/day.
Thus, if you are taking one tablet per day as recommended for both medications by most healthcare professionals then Olumiant is less expensive on a per-day treatment basis. However, cost should not be your primary consideration in determining which drug is right for you - efficacy and side effects play an equally important role.
As far as we know currently there are no generic versions available for either Olumiant or Xeljanz. These are novel treatments in the field of rheumatology and still under patent protection; hence their high costs reflect the investment into research and development that pharmaceutical companies have made.
Popularity of Olumiant and Xeljanz
Baricitinib, under the brand name Olumiant, and tofacitinib, sold as Xeljanz, are both Janus kinase (JAK) inhibitors used in the treatment of moderate to severe rheumatoid arthritis.
Olumiant was prescribed approximately 0.5 million times globally in 2020 - a significant increase since its approval by FDA in 2018. Baricitinib's use has been steadily increasing over recent years due to its efficacy and tolerability.
On the other hand, Xeljanz had around 800 thousand prescriptions filled in the US alone during 2020. Tofacitinib has been on the market longer than baricitinib (approved by FDA in 2012), which may explain some of its higher usage rates. It accounted for just over half of all JAK inhibitor prescriptions last year.
Both drugs have demonstrated good efficacy; however their safety profiles differ slightly with certain risks linked more heavily with one drug or another - conversations about these potential risks are important between patients and healthcare providers when choosing between them.
Conclusion
Both Olumiant (baricitinib) and Xeljanz (tofacitinib) have been shown to be effective in patients with moderate to severe rheumatoid arthritis, and are backed by substantial clinical studies indicating that they are more effective than placebo treatments. The two drugs may occasionally be used together, but this should only be done under careful supervision of a physician as they both suppress the immune system and can increase the risk of infections. Due to their different mechanisms of action, with Olumiant inhibiting JAK1 and JAK2 enzymes whereas Xeljanz inhibits JAK1, JAK2 and JAK3 enzymes, they may differ in efficacy or side effects for individual patients.
Olumiant is usually taken once daily while Xeljanz can be taken twice daily depending on the prescribed dosage. Both drugs may require some time before the full benefits are seen.
Side effect profiles are similar between these medications; common side effects include upper respiratory tract infections, nausea, rash etc., but serious side effects such as blood clots or severe infections may also occur. Patients must closely monitor their health during treatment especially if any signs of infection show up like fever or persistent sore throat. It's important that patients seek medical help immediately if they notice worsening symptoms or new ones.