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Orencia vs Remicade
Introduction
For patients with rheumatoid arthritis or other types of autoimmune diseases, certain drugs that modulate the immune system can help in managing symptoms and slowing disease progression. Orencia and Remicade are two such biologic medications often prescribed for these conditions. Both work by targeting specific parts of the immune system to reduce inflammation, but they do so in different ways. Orencia works by inhibiting T-cell activation, a crucial step in the body's immune response, while Remicade is classified as an anti-tumor necrosis factor (TNF) alpha agent which blocks TNF-alpha, a cytokine involved in systemic inflammation.
What is Orencia?
Abatacept (the generic name for Orencia) was the first drug of its class known as selective costimulation modulators, which marked a significant advancement in the treatment of autoimmune diseases such as rheumatoid arthritis. Abatacept was first approved by the FDA in 2005. It works by preventing T-cells from becoming activated, effectively "calming" them and reducing inflammation. This is prescribed for moderate to severe rheumatoid arthritis when other treatments have failed or are not suitable.
On the other hand, Infliximab (Remicade's generic name) falls under a class of drugs called TNF alpha inhibitors and has been used widely since its FDA approval in 1998. It acts by blocking tumour necrosis factor alpha (TNFα), an inflammatory substance produced by your body, thereby reducing inflammation and halting disease progression.
While both drugs reduce immune system activity leading to decreased inflammation, their mode of action differs considerably resulting in different side-effect profiles- Orencia may be better tolerated with fewer serious side effects compared to Remicade which can affect more systems within your body due to its stronger effect on your immune system.
What conditions is Orencia approved to treat?
Orencia is approved for the treatment of several types of arthritis:
- Rheumatoid arthritis (RA)
- Juvenile Idiopathic Arthritis (JIA) in patients 2 years and older
- Psoriatic arthritis (PsA)
It can be used as a monotherapy or in combination with methotrexate or other non-biologic Disease Modifying Antirheumatic Drugs (DMARDs).
How does Orencia help with these illnesses?
Orencia works to manage rheumatoid arthritis by reducing the activity of T cells, a type of white blood cell that plays a crucial role in immune responses. It does this by binding to and blocking a protein called CD80/86 on the surface of these cells, preventing them from fully activating and thereby decreasing inflammation. T cells are involved in various immune reactions, including those that cause inflammation and damage in joints, as seen in conditions like rheumatoid arthritis. It is thought that individuals with autoimmune diseases like RA have overactive T cells. Therefore, by reducing their activity through Orencia treatment, patients can limit the negative effects associated with excessive inflammation and help manage their condition.
On another hand, Remicade reduces symptoms of inflammatory conditions such as Crohn's disease or Rheumatoid Arthritis (RA) by neutralizing TNF-alpha (tumor necrosis factor alpha), an inflammatory substance produced by your body. This helps to decrease swelling/inflammation which leads to improved physical function.
What is Remicade?
Remicade, the brand name for infliximab, is a type of medication known as a tumor necrosis factor (TNF) inhibitor. It works by binding to and blocking TNF-alpha, an inflammatory substance in your body that contributes to rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis and Crohn's disease among other conditions. This mechanism reduces inflammation and alleviates the associated symptoms. Remicade was first approved by the FDA in 1998.
Unlike Orencia which targets T-cells specifically involved in immune response activation, Remicade has a broader action on TNF-alpha seen across multiple cell types involved in inflammation. Therefore it may be more effective for patients with severe forms of these diseases or those who don't respond well to other medications like Orencia.
Common side effects of Remicade are similar to many immuno-suppressive drugs including increased risk of infections due its action on the immune system; however it doesn’t commonly cause issues such as weight gain or sexual dysfunction unlike some antidepressants such as Prozac.
What conditions is Remicade approved to treat?
Remicade is a widely prescribed medication that has been approved by the FDA for the treatment of several autoimmune disorders, including:
- Rheumatoid arthritis
- Psoriasis and psoriatic arthritis
- Ulcerative colitis and Crohn's disease
- Ankylosing spondylitis
It works by targeting TNF-alpha, a protein in your body that can cause inflammation when produced in excess.
How does Remicade help with these illnesses?
Tumor necrosis factor (TNF) is a cytokine involved in systemic inflammation and plays a critical role in the body's immune response. It is implicated in several autoimmune diseases, including rheumatoid arthritis, Crohn's disease, and psoriasis. Remicade works by inhibiting the action of TNF in the body, thereby alleviating some of the symptoms of these conditions. Its effect on various aspects of immunity may also play roles in its action as an immunosuppressive drug. Since it has a broader range of effects compared to Orencia that specifically targets T-cell activation - another key player in autoimmune responses - Remicade might be selected when a patient does not respond well to other treatments or may be combined with other drugs for maximum therapeutic benefit.
How effective are both Orencia and Remicade?
Abatacept (Orencia) and infliximab (Remicade) are both approved by the FDA for the treatment of rheumatoid arthritis, with Remicade being approved a few years earlier than Orencia. Both drugs act on different aspects of the immune system to reduce inflammation. Abatacept interferes with T-cell activation while Infliximab targets and neutralizes TNF-alpha, a chemical messenger in the inflammatory process.
In clinical trials directly comparing these two drugs, both have shown similar efficacy in reducing symptoms of rheumatoid arthritis as well as comparable safety profiles. Furthermore, there were no significant differences between patients receiving Abatacept or Infliximab when measuring their ability to alleviate symptoms of this condition.
A 2007 meta-analysis showed that Abatacept is effective at improving quality of life from the first month of treatment onwards, has fewer side effects compared to many other anti-rheumatic drugs and is generally well tolerated even by elderly populations. The same study reported that despite being relatively new at that time, it was becoming one of the more frequently prescribed biologic agents for treating moderate-to-severe rheumatoid arthritis due to its unique mechanism.
A 2011 review indicated that Infliximab appears more potent than placebo in managing rheumatoid arthritis and has comparable efficacy with other common biologics. However, it's usually considered after conventional disease-modifying antirheumatic drugs (DMARDs). Significant research on its use involves co-prescription alongside methotrexate so data confirming its efficacy as stand-alone therapy may be less robust than for abatacept. Also worth noting is evidence suggesting that infusion reactions could be an issue with infliximab but not orencia which might make latter a better choice for some patient groups.
At what dose is Orencia typically prescribed?
Dosages of Orencia for adults with rheumatoid arthritis, psoriatic arthritis, or juvenile idiopathic arthritis are based on weight. Adults who weigh less than 60 kg should receive a dose of 500 mg, those between 60 to100 kg need a dose of 750 mg and individuals over 100 kg require a dosage of 1 g. These dosages are administered via intravenous infusion at weeks zero (initial), two and four; thereafter every four weeks. For children and adolescents with JIA, the dosage is determined by their body weight as well - kids weighing less than or equal to 75 kg receive an IV dose equivalent to10mg/kg while those above get the adult doses respectively. Remember that in all cases these medications should be administered under medical supervision and any adjustment in dosing must be done by your healthcare provider.
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At what dose is Remicade typically prescribed?
Remicade therapy usually begins with a dosage of 3-5 mg/kg, administered as an intravenous infusion. The initial dose is followed by additional infusions at two and six weeks after the first treatment, then every eight weeks thereafter. Depending on your response to treatment, your doctor may adjust the dose up to a maximum of 10mg/kg or alter the frequency to every four weeks. It's crucial not to miss these regular infusions once you start Remicade treatment because it helps maintain consistent drug levels in your body for optimal effect against conditions like rheumatoid arthritis, Crohn's disease and ulcerative colitis among others.
What are the most common side effects for Orencia?
Common side effects of Orencia may include:
- Headache
- Dizziness
- Back pain and sore throat
- Coughing, runny or stuffy nose (signs of upper respiratory tract infection)
- Nausea
- Mild stomach pain
- Diarrhea
While Remicade can cause similar side effects, it also has some distinct ones like:
- Fever and chills
- Rashes, itching, hives
- Difficulty breathing or swallowing (indicating an allergic reaction)
It is important to note that both drugs have more serious potential side effects related to their impact on the immune system. Always consult with a healthcare professional for personalized advice.
Are there any potential serious side effects for Orencia?
When considering Orencia and Remicade, it's essential to be aware of their potential side effects. Although these medications are used to treat similar conditions, the side effects can vary somewhat:
- Signs of serious infections: Fever; night sweats; tiredness; warm, red, or painful skin or sores on your body; coughing up blood
- Allergic reactions: Hives or itching skin; swollen face, eyelids, lips tongue or throat; trouble breathing
- Unusual neurological symptoms: Weakness in arms/legs; vision changes such as blurred vision/double vision/bulging eyes/protruding eyeballs
- Cardiovascular issues: Chest pain/discomfort/tightness/pressure/heavy feeling/pain spreading to arm/back/jaw/shoulder/throat/sweating/faint feel
- Decreased sodium level - confusion/muscle twitching/seizure/extreme fatigue/headache/difficulty concentrating/memory problems/unsteady walk; Severe reaction affecting multiple body systems (Stevens-Johnson syndrome/toxic epidermal necrolysis) - fever/rash with blistering and peeling. Be sure to contact your healthcare provider immediately if you experience any of these symptoms while taking either Orencia or Remicade.
What are the most common side effects for Remicade?
Common and potential side effects associated with Remicade include:
- Headache, dizziness
- Respiratory infections such as sinusitis or sore throat
- Stomach pain, nausea
- Rash or itching
- Infusion reactions like fever, chills
- Muscle or joint pain
- Fatigue, weakness These adverse effects can occur during treatment with Remicade for conditions like rheumatoid arthritis, Crohn's disease, ulcerative colitis among others. Please keep in mind that while these are possible side effects of this medication, not everyone experiences them.
Are there any potential serious side effects for Remicade?
Remicade, while generally well-tolerated, can in rare cases cause severe side effects. If you are taking Remicade and notice any of the following symptoms, seek immediate medical attention:
- Signs of an allergic reaction including difficulty breathing; swelling of your face, lips, tongue or throat; hives
- Serious skin reactions such as a rash that spreads and causes blistering and peeling
- Symptoms of heart failure including shortness of breath with light activity or lying down, chest pain or discomfort when you exert yourself physically
- Severe upper stomach pain spreading to your back accompanied by vomiting and a fast heart rate
- Liver problems which may include nausea (upper stomach pain), tired feeling or loss of appetite followed by dark urine and jaundice (yellowing of the skin or eyes)
Also pay close attention to changes in mood or behavior: if you experience confusion, memory problems, hallucinations (seeing things) do not hesitate to contact your healthcare provider.
Contraindications for Orencia and Remicade?
Both Orencia and Remicade, along with most other immunosuppressive drugs, may worsen symptoms in some people. If you notice an increase in illness or infections, please seek immediate medical attention.
Neither Orencia nor Remicade should be taken if you are taking or have been taking any live vaccines. Always inform your healthcare provider about the medications and vaccines that you are currently on; live vaccines need to be administered at least 2 weeks before starting treatment with these drugs to prevent dangerous interactions.
Additionally, both Orencia and Remicade can exacerbate conditions such as heart failure or liver disease. Therefore, it is important that you share your complete medical history—especially of tuberculosis (or a positive TB test), any type of infection (including open sores or cuts), hepatitis b infection, cancer, heart disease/heart failure/disease of the nervous system (such as seizures)—with your doctor prior to beginning treatment.
Moreover, before undergoing surgery or dental procedures while on either drug make sure to notify all healthcare professionals involved in your care. This is because stopping these medicines for surgery then restarting them can raise the risk of infection.
How much do Orencia and Remicade cost?
For the brand name versions of these drugs:
- The price of a single dose (125 mg) of Orencia can range from approximately $1,500 to $2,000. Considering that it is typically administered every 4 weeks, this works out to about $50-$67/day.
- On the other hand, Remicade costs around $1,300 to $2,500 per infusion (100 mg). It's usually given once every 6-8 weeks which makes it roughly about $21-$42/day.
Thus if you are on the typical schedule for each drug (every four weeks for Orencia and every six-eight weeks for Remicade), then Remicade tends to be less expensive on a per-day treatment basis. However cost should not be your primary consideration in determining which of these drugs is right for you.
Please note that there are currently no generic versions available for either biologic medication: Orencia (abatacept) or Remicade (infliximab). The prices mentioned also do not take into account any health insurance coverage you may have which could significantly lower your out-of-pocket expenses.
Popularity of Orencia and Remicade
Abatacept, known by the brand name Orencia, is a medication used to treat autoimmune diseases such as rheumatoid arthritis and juvenile idiopathic arthritis. In 2019, it was estimated that approximately 200 thousand people in the US were prescribed this drug. Abatacept accounted for about 5% of all prescriptions for biologic drugs used to treat these conditions and its use has been generally increasing since its approval in 2005.
Infliximab, sold under the brand name Remicade among others, is another medication used for similar purposes including Crohn's disease and ulcerative colitis. It was prescribed to around 500 thousand people in the USA in 2019 which accounts for nearly 13% of all prescriptions for biologics treating these types of conditions. The prevalence of infliximab use has remained steady over time despite facing competition from other newer medications.
Conclusion
Both Orencia (abatacept) and Remicade (infliximab) are used as treatments for rheumatoid arthritis, among other immune-related conditions. They have proven to be more effective than placebo in numerous clinical studies, with a long-standing record of usage in patients. In some instances, these drugs might be used concomitantly but this is subject to careful consideration by a physician due to potential drug interactions.
Their mechanisms of action differ: Orencia inhibits the activation of T cells which play a key role in inflammation associated with autoimmune disorders while Remicade works by blocking tumor necrosis factor alpha (TNF-alpha), an inflammatory substance produced by the body.
Remicade is often considered as first-line treatment for severe cases or those not responding well to traditional DMARDs (disease-modifying antirheumatic drugs). Orencia may be selected if patients do not respond adequately or show intolerance towards anti-TNF medications like Remicade.
Neither medication is available in generic form currently and both can require several weeks before noticeable effects arise. The side effect profile between these two biologic therapies varies; they are generally well-tolerated but carry risks including serious infections and allergic reactions. For both therapies, patients must monitor their health closely when starting treatment and should seek medical help immediately if they notice signs of infection such as fever or persistent sore throat.