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Rinvoq vs Otezla
Introduction
For patients with psoriatic arthritis or other types of auto-immune diseases, certain drugs that alter the immune response can help in managing inflammation and controlling symptoms. Rinvoq and Otezla are two such drugs that are prescribed for these conditions. They each impact different pathways in the immune system but both have anti-inflammatory effects on patients with autoimmune disorders.
Rinvoq is a Janus kinase (JAK) inhibitor which works by blocking specific enzymes called JAKs from triggering inflammation responses. This helps to reduce swelling, pain, and other symptoms associated with rheumatoid arthritis.
On the other hand, Otezla is classified as a phosphodiesterase 4 (PDE4) inhibitor that works by decreasing levels of inflammatory substances within the body. It's primarily used to treat moderate-to-severe plaque psoriasis and active psoriatic arthritis. Both medications play crucial roles in providing relief from discomforting autoimmune disease symptoms.
Rinvoq vs Otezla Side By Side
| Attribute | Rinvoq | Otezla |
|---|---|---|
| Brand Name | Rinvoq | Otezla |
| Contraindications | Should not be taken with biologic drugs for the same condition due to a higher risk of serious infections. Screening for tuberculosis (TB) is crucial before starting treatment. | Should not be taken with biologic drugs for the same condition due to a higher risk of serious infections. Screening for tuberculosis (TB) is crucial before starting treatment. |
| Cost | $5,900 for a month's supply | $3,500 for a month's supply |
| Generic Name | Upadacitinib | Apremilast |
| Most Serious Side Effect | Severe allergic reactions, signs of infection, changes in mood or behavior like depression or thoughts about suicide, liver problems | Increased feelings of depression or suicidal thoughts, severe diarrhea leading to dehydration |
| Severe Drug Interactions | Increased risk of serious infections when combined with other immunosuppressive drugs | Not specified, but caution is advised when combined with other drugs that may increase the risk of depression or gastrointestinal issues |
| Typical Dose | 15 mg once daily | 30 mg twice daily after an initial titration period |
What is Rinvoq?
Upadacitinib (the generic name for Rinvoq) is a Janus kinase inhibitor that marked significant progress from the first class of drugs used to treat moderate-to-severe rheumatoid arthritis, psoriatic arthritis and ankylosing spondylitis. Approved by the FDA in 2019, Rinvoq operates by inhibiting one or more of the Janus kinase family enzymes, thus interrupting the pathway that leads to inflammation. It is prescribed as a treatment when other medicines have failed to provide adequate relief.
On the other hand, Apremilast (commonly known as Otezla), which was approved by FDA in 2014, falls under a different class of medication called PDE4 inhibitors and it's mainly used for psoriasis and psoriatic arthritis. This drug works differently than Rinvoq; it reduces inflammation inside your body and could be less likely to suppress your immune system broadly.
While both medications are effective at reducing symptoms related to their respective conditions, they each have unique side effects due to their actions on different pathways within the body. Upadacitinib may cause serious infections while apremilast can lead to diarrhea or nausea but has lesser chances causing serious infections.
What conditions is Rinvoq approved to treat?
Rinvoq is approved for the treatment of various autoimmune disorders:
- Rheumatoid arthritis, a chronic inflammatory disorder affecting many joints
- Psoriatic arthritis, an arthritic condition associated with psoriasis
- Ankylosing spondylitis, a type of arthritis that affects the spine
It's also under consideration for approval in other conditions such as ulcerative colitis and atopic dermatitis.
How does Rinvoq help with these illnesses?
Rinvoq is designed to manage the symptoms of moderate to severe rheumatoid arthritis by inhibiting an enzyme known as Janus kinase (JAK). This enzyme plays a crucial role in the body's immune response, including inflammatory processes. By interrupting JAK pathways, Rinvoq reduces inflammation and can help patients control their condition and alleviate pain. The drug essentially modulates the immune system's response that usually results in joint damage and inflammation.
Otezla, on the other hand, works differently from Rinvoq but aims to achieve similar outcomes for patients with psoriatic arthritis or moderate-to-severe plaque psoriasis. Otezla blocks an enzyme called phosphodiesterase 4 (PDE4) within immune cells. By doing this, Otezla helps reduce inflammation associated with these diseases by regulating specific proteins involved in inflammatory reactions.
While both drugs aim to mitigate inflammatory responses related to autoimmune disorders, they target different enzymes within those complex biological systems. Deciding between them would depend on individual patient needs and physician recommendations based on disease type, severity of symptoms among other factors.
What is Otezla?
Otezla, the brand name for apremilast, is a phosphodiesterase 4 (PDE4) inhibitor. This means it works by increasing levels of cyclic adenosine monophosphate (cAMP) in cells which helps to regulate immune responses and inflammation. Otezla was first approved by the FDA in 2014. It's specifically designed to treat certain types of psoriasis and psoriatic arthritis.
Unlike Rinvoq, Otezla does not function as a Janus kinase (JAK) inhibitor and hence doesn't interfere with JAK-STAT signaling pathway involved in various cellular functions including cell proliferation, survival, differentiation and apoptosis. This makes its side-effect profile different than that of Rinvoq; while both medications can cause nausea or diarrhea initially, unlike Rinvoq, Otezla does not have black box warnings about serious infections or malignancies associated with its use.
The specific mechanism action on PDE4 makes Otezla beneficial for those suffering from moderate-to-severe plaque psoriasis who are candidates for phototherapy or systemic therapy but do not respond well to typical treatments.
What conditions is Otezla approved to treat?
Otezla is an approved medication for the management of various conditions, including:
- Moderate to severe plaque psoriasis in patients who are candidates for phototherapy or systemic therapy
- Active psoriatic arthritis
- Oral ulcers associated with Behçet's Disease in adults.
How does Otezla help with these illnesses?
Phosphodiesterase 4 (PDE4) is an enzyme that plays significant roles in inflammatory processes within the body. It is known to be involved in conditions like psoriasis and psoriatic arthritis. Otezla works by inhibiting PDE4, thereby reducing inflammation and alleviating some of the symptoms associated with these conditions. Its action on various immune cells may also play crucial roles in its effectiveness as a treatment for such autoimmune diseases. Since it does not significantly affect tumor necrosis factor (TNF), it might be prescribed when a patient does not respond well to typical TNF inhibitors (such as Rinvoq), or it may be combined with them for enhanced effect.
How effective are both Rinvoq and Otezla?
Both upadacitinib (Rinvoq) and apremilast (Otezla) are approved by the FDA for treating moderate to severe forms of rheumatoid arthritis and psoriatic arthritis. These two drugs have different mechanisms of action: Rinvoq is a JAK inhibitor, which means it interferes with the JAK-STAT signaling pathway that plays a key role in inflammatory responses; Otezla is a PDE4 inhibitor, which reduces inflammation by raising levels of cyclic AMP, a molecule that suppresses immune cell activity.
The effectiveness of Rinvoq and Otezla was directly studied in double-blind clinical trials. Both drugs showed significant efficacy in relieving symptoms such as joint swelling, pain, stiffness and skin plaques. In these studies, neither drug led to serious side effects in most patients; however, each has unique potential adverse effects worth noting: Rinvoq can increase risk of infections due to its immunosuppressive action while Otezla may lead to weight loss or mood changes.
A 2019 review on Rinvoq demonstrated its ability to reduce signs and symptoms starting from the first week of treatment. It has become one of widely prescribed drugs for rheumatoid arthritis due to its rapid onset action compared with other disease-modifying antirheumatic drugs (DMARDs). The optimal dose appears to be 15 mg once daily for rheumatoid arthritis patients.
On the other hand, an analysis done in 2020 indicated that Otezla seems effective against both Psoriasis and Psoriatic Arthritis but typically considered after failure or intolerance with DMARDs because it's less potent than biologic agents like TNF inhibitors or newer small molecules like JAK inhibitors. Nonetheless due its unique mechanism of action without major organ toxicity or need for lab monitoring makes it an attractive option for certain patient population who prefers oral medication over injections.
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At what dose is Rinvoq typically prescribed?
Oral dosages of Rinvoq are typically 15 mg once daily for the treatment of moderate to severe rheumatoid arthritis in adults. On the other hand, Otezla's standard dosage is 30 mg twice daily after an initial titration period. Both medications should be adjusted according to individual patient responses and tolerability over time under a healthcare provider's supervision. For both Rinvoq and Otezla, it's important not to exceed the recommended maximum dosage set by your doctor or healthcare professional.
At what dose is Otezla typically prescribed?
Otezla treatment is typically initiated at a dosage of 10 mg/day. The dose can then be gradually increased over the first five days, reaching a maintenance dosage of 30 mg two times per day from Day 6 onward. This titration strategy aims to reduce potential gastrointestinal symptoms associated with initial therapy. The maximum recommended dose is 60mg/day divided into two doses of 30 mg and taken approximately twelve hours apart, which may be considered if there's no response to the regular treatment after several weeks. As always, it's important to carefully follow your healthcare provider's instructions when taking any medication.
What are the most common side effects for Rinvoq?
Common side effects of Rinvoq include:
- Upper respiratory tract infections
- Nausea
- Pyrexia (fever)
- Cough
- Abdominal pain, constipation, diarrhea or indigestion
- Fatigue and asthenia
- Headache and dizziness
- Rash
- Somnolence (sleepiness/drowsiness)
On the other hand, Otezla is associated with its own set of common side effects which includes:
-Diarrhea
-Nausea
-Vomiting
-Decreased appetite
-A headache.
Remember to always consult a healthcare professional if you are experiencing any unusual symptoms while taking these drugs.
Are there any potential serious side effects for Rinvoq?
Rinvoq and Otezla are both used to treat certain types of arthritis, but each can have different side effects. In some rare instances, Rinvoq can cause:
- Severe allergic reactions: hives, difficult breathing or swallowing, swelling in your face or throat
- Signs of infection: fever, chills, sore throat, shortness of breath
- Changes in mood or behavior like depression or thoughts about suicide
- Liver problems indicated by symptoms such as yellowing eyes/skin (jaundice), dark urine and severe stomach/abdominal pain
Otezla may cause:
- Diarrhea leading to significant weight loss
- Increased risk of depression and suicidal ideation
- Respiratory tract infections indicated by coughs with mucus
It is crucial that you keep an open line of communication with your healthcare provider so they can monitor these potential side effects throughout the course of treatment.
What are the most common side effects for Otezla?
Otezla, another medication for treating psoriatic arthritis and plaque psoriasis, may lead to some side effects such as:
- Diarrhea or upset stomach
- Nausea and vomiting
- Tension headache
- Unintentional weight loss
- Mood changes or depression
- Respiratory tract infection (like stuffy nose) While Otezla does not typically cause a dry mouth or ringing in the ears, it can lead to other discomforts like insomnia and body aches. It's important to contact your healthcare provider if you experience these symptoms persistently after starting the drug regimen.
Are there any potential serious side effects for Otezla?
While Otezla is typically well-tolerated by most individuals, it's important to be aware of potential side effects and symptoms indicative of a more serious reaction. These could include:
- Signs of an allergic reaction including hives, itching, difficulty breathing or swallowing; swelling of the face, lips, tongue or throat
- Increased feelings of depression or suicidal thoughts
- Rapid or irregular heart rate
- Unexplained weight loss or gain
- Blood in your stools (indicating possible stomach/intestinal bleeding)
- Severe diarrhea leading to dehydration: dry mouth/throat/eyes, feeling confused
Please note that while these side effects are rare they should not be ignored. If you experience any unusual changes after starting Otezla treatment immediately consult with your healthcare provider.
Contraindications for Rinvoq and Otezla?
Both Rinvoq and Otezla, along with most similar rheumatoid arthritis medications, may worsen symptoms of infections or cause new infections. If you notice any signs of infection such as fever, chills, coughing up mucus or increased fatigue, please seek immediate medical attention.
Neither Rinvoq nor Otezla should be taken if you are taking biologic drugs for the same condition. This is due to a higher risk of serious infections when these types of medications are combined. Always inform your physician about all other medications you are currently on; some will require a certain period to clear from the system in order to prevent harmful interactions with Rinvoq and Otezla.
Before starting treatment with either Rinvoq or Otezla, it's crucial that your doctor screens you for tuberculosis (TB). Both these drugs can increase the chances of reactivating latent TB. Furthermore, make sure to keep regular appointments with your doctor while on this medication so they can monitor your response and adjust doses accordingly.
How much do Rinvoq and Otezla cost?
For the brand name versions of these medications:
- The price for one month's supply of Rinvoq (15 mg), which is around 30 tablets, averages approximately $5,900. This works out to about $197/day.
- For Otezla, a monthly supply (60 tablets of 30 mg each) costs around $3,500 on average. That translates into roughly $117/day.
Thus, if you are taking a daily dosage for either drug, then brand-name Otezla is less expensive on a per-day treatment basis than Rinvoq. However, cost should not be the primary factor in determining which medication is right for you.
As of now there are no generic forms available for either Rinvoq or Otezla as they are relatively new and still under patent protection. As with all prescription drugs though - especially high-cost ones like these - it’s important to understand insurance coverage options that may help offset some cost.
Popularity of Rinvoq and Otezla
Upadacitinib, under the brand name Rinvoq, is a newer medication used for managing moderate to severe rheumatoid arthritis. Though it was only approved by the FDA in 2019, its novel mechanism of action and effectiveness have led to an increasing number of prescriptions. However, as it's a relatively new product on the market with limited long-term safety data available compared to some other drugs used for similar purposes, its uptake has been cautious.
Apremilast, marketed as Otezla since its approval in 2014, is prescribed for treating patients with psoriasis or psoriatic arthritis. It has seen steady prescription numbers over recent years due to its unique mode of action and tolerable side-effect profile. Both Rinvoq and Otezla represent advances in disease management options beyond traditional DMARDs (disease-modifying antirheumatic drugs) offering potentially improved outcomes for patients living with these chronic diseases.
Conclusion
Both Rinvoq (upadacitinib) and Otezla (apremilast) are relatively newer medications used to treat moderate to severe rheumatoid arthritis and psoriatic arthritis, backed by clinical studies indicating their superiority over placebo treatments. Sometimes, these drugs may be combined with other medication for better results, but this should be done under careful supervision of a physician as there can be potential drug interactions.
Rinvoq works primarily by inhibiting the Janus kinase enzymes which play a key role in inflammation process while Otezla operates differently by inhibiting an enzyme called PDE4 that plays a role in immune responses leading to inflammation. While both drugs could potentially serve as first-line treatment options when traditional DMARDs (Disease-Modifying Antirheumatic Drugs) do not work well or cannot be tolerated, they are often used as second-line treatments due to their cost.
As they are still under patent protection, neither Rinvoq nor Otezla is available yet in generic form which would have represented significant cost savings especially for patients who must pay out of pocket.
The side effect profile between the two is comparable; however, it's important that patients closely monitor their symptoms and seek medical help immediately if they notice any new or worsening symptoms such as mood changes or thoughts about self-harm.
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Refrences
- Deeks, E. D. (2015, July 29). Apremilast: A Review in Psoriasis and Psoriatic Arthritis. Drugs. Springer Science and Business Media LLC.http://doi.org/10.1007/s40265-015-0439-1
- Duggan, S., & Keam, S. J. (2019, October 22). Upadacitinib: First Approval. Drugs. Springer Science and Business Media LLC.http://doi.org/10.1007/s40265-019-01211-z
- Schafer, P. H., Parton, A., Capone, L., Cedzik, D., Brady, H., Evans, J. F., … Chopra, R. (2014, September). Apremilast is a selective PDE4 inhibitor with regulatory effects on innate immunity. Cellular Signalling. Elsevier BV.http://doi.org/10.1016/j.cellsig.2014.05.014
- Chimenti, M. S., Gramiccia, T., Saraceno, R., Bianchi, L., Garofalo, V., Buonomo, O., … Chiricozzi, A. (2015, August 4). Apremilast for the treatment of psoriasis. Expert Opinion on Pharmacotherapy. Informa Healthcare.http://doi.org/10.1517/14656566.2015.1076794