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Xeljanz vs Remicade
Introduction
For patients with rheumatoid arthritis or other types of autoimmune diseases, certain drugs that alter the immune system's response can help in reducing inflammation and managing symptoms. Xeljanz and Remicade are two such drugs that are prescribed for these conditions. They each interact differently within the body but both have anti-inflammatory effects in patients with autoimmune disorders. Xeljanz is a Janus kinase (JAK) inhibitor, disrupting the signaling pathway used by various cytokines involved in inflammation. Remicade, on the other hand, is classified as a tumor necrosis factor alpha (TNFα) blocker; it binds to TNFα and prevents it from interacting with its receptors, thereby reducing inflammatory responses.
What is Xeljanz?
Tofacitinib (the generic name for Xeljanz) is an oral, small molecule drug that inhibits Janus kinase (JAK), a group of enzymes that play a crucial role in the process of inflammation. It was approved by the FDA in 2012 and has effectively revolutionized the treatment of moderate to severe rheumatoid arthritis (RA). Unlike traditional DMARDs which suppress your entire immune system, Tofacitinib specifically targets proteins involved in the inflammatory response.
In contrast, Infliximab (the generic name for Remicade) is part of an earlier class of drugs known as biologics and was first approved by the FDA back in 1998. It works by inhibiting TNF-alpha, a protein produced during inflammation. As it is given intravenously rather than orally, patients receiving this treatment must visit their healthcare provider regularly - typically every six to eight weeks after initial doses.
Both medications are effective treatments for RA but they work differently and may have different side effects profiles due to their mechanism actions.
What conditions is Xeljanz approved to treat?
Xeljanz is authorized for use in various inflammatory conditions, including:
- Rheumatoid arthritis (RA), an autoimmune disease that causes joint pain and damage
- Psoriatic arthritis (PsA), a type of arthritis affecting some people with psoriasis
- Ulcerative colitis (UC), a disease that causes inflammation and ulcers in the lining of the large intestine.
How does Xeljanz help with these illnesses?
Xeljanz helps to manage rheumatoid arthritis and other inflammatory conditions by inhibiting the activity of Janus kinases, enzymes that play a crucial role in the signaling pathway for various cytokines involved in inflammation. By blocking these enzymes, Xeljanz prevents the activation of immune cells that cause inflammation and damage to joints or organs. This mechanism is different from but analogous to how serotonin reuptake inhibitors work: both aim at regulating imbalances within body systems—immune response for Xeljanz, neural communication for Prozac—to alleviate symptoms and improve overall health.
On the other hand, Remicade works similarly but with a more targeted approach. It's a biologic therapy that directly targets tumor necrosis factor alpha (TNF-alpha), a specific pro-inflammatory cytokine heavily involved in autoimmune diseases like rheumatoid arthritis or Crohn's disease. By binding TNF-alpha, Remicade neutralizes its effect thereby reducing inflammation and alleviating symptoms.
Both medicines offer relief from chronic inflammatory conditions but their differences lie largely in administration methods (Xeljanz is oral while Remicade is intravenous) and side effects profiles which should be discussed with your healthcare professional when choosing between them.
What is Remicade?
Remicade, also known as infliximab, is a TNF alpha inhibitor and monoclonal antibody. This means that it targets the tumor necrosis factor-alpha (TNFα), a chemical messenger involved in systemic inflammation. Remicade was first approved by the FDA in 1998 for treating autoimmune diseases like Crohn's disease and rheumatoid arthritis. Unlike Xeljanz which is an oral medication working inside cells to block enzymes called Janus kinases from triggering inflammation, Remicade works outside of the cells blocking TNFα from continuing inflammatory response cycle. Its action can be beneficial for patients who do not respond well to other medications such as Xeljanz or prefer intravenous administration method over oral intake. Because of its different mechanism of action, its side-effect profile may differ too; it does not cause gastrointestinal issues often associated with oral medications but may lead to infusion reactions or increased risk of infections due to immunosuppression.
What conditions is Remicade approved to treat?
Remicade has received approval for the management of multiple conditions:
- Rheumatoid arthritis, in conjunction with methotrexate
- Crohn's disease and ulcerative colitis
- Ankylosing spondylitis
- Psoriatic arthritis
- Plaque psoriasis in adults who haven't responded to other therapies.
How does Remicade help with these illnesses?
Tumor Necrosis Factor (TNF) is a substance in the body that causes inflammation and plays a significant role in autoimmune conditions such as rheumatoid arthritis. Remicade works by blocking the action of TNF, thereby reducing inflammation and other symptoms associated with these disorders. It's an anti-TNF drug which is biologically created and used for several chronic inflammatory diseases. Unlike Xeljanz, which comes as a pill and inhibits janus kinases proteins to reduce inflammation, Remicade is delivered via infusion in hospitals or clinics directly into your bloodstream. Because it acts more broadly on the immune system, it may be preferred when patients don't respond effectively to oral medications like Xeljanz or need more aggressive treatment.
How effective are both Xeljanz and Remicade?
Both tofacitinib (Xeljanz) and infliximab (Remicade) are effective in managing symptoms of rheumatoid arthritis and other inflammatory conditions, approved by the FDA a little over a decade apart. They act on different elements of the immune system; Xeljanz inhibits enzymes called Janus kinases, which play a key role in the inflammation process, while Remicade blocks tumor necrosis factor alpha (TNF-alpha), another important player in inflammation.
The effectiveness of both drugs has been demonstrated in numerous clinical trials. For instance, studies have shown that Xeljanz can significantly reduce signs and symptoms of rheumatoid arthritis, improve physical function, and retard structural damage progression. A 2012 double-blind trial found that patients receiving Xeljanz had similar levels of symptom relief as those taking methotrexate - a common first-line therapy for rheumatoid arthritis.
Similarly, Remicade has also been proven effective at reducing pain and swelling associated with rheumatoid arthritis. In fact, it was one of the first anti-TNF agents developed for this purpose. It's generally well-tolerated but like all drugs does carry some risk of side effects such as infections due to its immunosuppressive action.
A 2009 meta-analysis indicated that although biologic disease-modifying antirheumatic drugs like Remicade were more efficacious than traditional systemic therapies alone for treating moderate-to-severe RA who failed initial treatment with methotrexate or other nonbiologic DMARDs., they do come with an increased risk profile including serious infections.
Despite these differences in mechanism and delivery method – Xeljanz is taken orally while Remicade requires intravenous infusion – both serve to disrupt damaging inflammatory pathways within the body. The decision between these two treatments would typically be based upon individual patient factors such as disease severity, comorbidities or personal preference.
At what dose is Xeljanz typically prescribed?
Oral dosages of Xeljanz typically range from 5-11mg twice a day, depending on the specific condition being treated. However, clinical studies have shown that for Rheumatoid arthritis and Psoriatic arthritis, a dosage of 5 mg twice daily is generally effective. In contrast, Remicade is administered through an intravenous infusion at doses usually between 3–10 mg/kg every six to eight weeks after induction therapy. Both treatments should be tailored based on individual patient response and tolerance to the medication. The maximum recommended dosage for Xeljanz does not exceed 22mg per day in any case.
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At what dose is Remicade typically prescribed?
Remicade therapy is typically initiated with a dosage of 3 mg/kg. This dose can then be increased to 5 mg/kg, depending on the patient's response and tolerance. The first three doses are usually given at weeks 0, 2, and 6. Subsequent dosages are administered every eight weeks thereafter. If there is no significant improvement in symptoms after the initial regimen or over time with continued treatment, your healthcare provider may consider increasing the dose to 10 mg/kg or shortening the interval between infusions to as little as four weeks apart.
What are the most common side effects for Xeljanz?
Common side effects of Xeljanz may include:
- Upper respiratory tract infections
- Headache
- Diarrhea
- Nasal congestion, sore throat, and runny nose (nasopharyngitis)
- High blood pressure (hypertension)
- Inflammation of the sinuses (sinusitis)
By comparison, Remicade might cause:
- Sinus infections and pharyngitis
- Upper respiratory tract infection
- Coughing and bronchitis
- Rash or hives on the skin
- Stomach pain and indigestion
- Nausea -General weakness/fatigue
It is important to note that these are not all the possible side effects. Always consult your healthcare provider about potential side effects for any medication you're considering.
Are there any potential serious side effects for Xeljanz?
While Xeljanz and Remicade are both used to treat rheumatoid arthritis among other conditions, they do have different side effects. For Xeljanz, some of the serious side effects can include:
- Signs of infection such as fever, chills or persistent sore throat
- Unusual tiredness
- Rapid heartbeat
- Swelling ankles/feet
- Unexplained weight loss
More severe reactions can be indicative of a weakened immune system due to the medication; these could include symptoms like easy bruising or bleeding, signs of tuberculosis (such as cough that doesn't go away, weight loss), or liver disease (including nausea/vomiting that doesn't stop, stomach/abdominal pain).
On the other hand for Remicade you need to watch out for:
- Symptoms related to heart failure such as shortness of breath/swelling ankles/feet/unusual tiredness/unusual/sudden weight gain.
- Allergic reaction including rash/hives/swelling on face/throat/difficulty breathing.
Both medications require immediate medical attention if any severe reactions occur. Always discuss potential risks with your healthcare provider before starting new medications.
What are the most common side effects for Remicade?
When contrasting Xeljanz with Remicade, it's important to note that patients on Remicade may experience a range of side effects. These can include:
- Headache and dizziness
- Coughing or trouble breathing
- Stomach pain accompanied by nausea or vomiting
- Skin rash and possible bruising
- Mood changes including confusion and nervousness
- Muscle or joint pain, back pain
- Difficulty sleeping (insomnia)
- Fever, sore throat leading to potential infections.
It should be noted that while some of these symptoms are similar to those experienced with Xeljanz, the frequency and severity could differ based on individual tolerance levels. Always consult your healthcare provider for advice tailored specifically to your health condition.
Are there any potential serious side effects for Remicade?
While Remicade is generally safe for most patients, it can cause some serious side effects in rare instances. These might include:
- Signs of a severe allergic reaction such as hives, difficulty breathing, swelling of the face or throat
- Symptoms that could indicate tuberculosis (TB) infection like persistent cough, weight loss, fatigue
- Unusual changes in mood or behavior potentially indicating neurological issues
- Blurred vision or eye pain which may signal an ocular issue
- Rapid heartbeats which could signify potential cardiac complications
- Severe skin reactions including redness and peeling
If you experience any of these symptoms when taking Remicade, seek immediate medical attention.
Contraindications for Xeljanz and Remicade?
Both Xeljanz and Remicade, like many medications for rheumatoid arthritis or inflammatory bowel disease, may increase the risk of certain infections. If you notice symptoms such as fever, persistent sore throat, coughing up blood, night sweats or weight loss while on these medications, please seek immediate medical attention.
Xeljanz and Remicade should not be taken if you are currently taking other biologic drugs or immunosuppressant medication. It's important to tell your physician about all the medications you're currently taking since interactions can occur. For instance, vaccines live attenuated ones should be avoided while on either medication due to a blunted immune response.
Furthermore, before starting on either Xeljanz or Remicade it is important to test for latent tuberculosis (TB) infection as both drugs could reactivate this condition; if positive treatment for TB should be initiated prior to starting therapy with these agents.
How much do Xeljanz and Remicade cost?
For the brand name versions of these drugs:
- The price of a 30-tablet bottle of Xeljanz (5 mg) averages around $2,900, which works out to approximately $96-$192/day, depending on your dosage.
- The price for one vial of Remicade (100mg) is about $1,300. As this drug is typically administered every six to eight weeks in a hospital or clinic setting and dosages could vary based on weight and condition being treated, it's difficult to provide an average daily cost.
Thus, if you are at the higher dosage range for Xeljanz (i.e., 10 mg/day), then Xeljanz can be more expensive than Remicade on a per-day treatment basis. Please note that cost should not be your only consideration when determining which of these drugs is right for you.
Neither Xeljanz nor Remicade currently has generic versions available as they are both biologic medications under patent protection. Consequently costs remain quite high compared with other forms of medication. However various patient assistance programs may help lower the costs depending upon eligibility criteria.
Popularity of Xeljanz and Remicade
Tofacitinib, available under the brand name Xeljanz, is a relatively new medication used to treat moderate to severe rheumatoid arthritis when methotrexate has not worked well enough. It's estimated that about 50,000 people in the US were prescribed Tofacitinib in 2020. As it is an oral medication taken twice daily, it offers convenience for patients who may have difficulty with injections or infusions.
Infliximab, known by its brand name Remicade, has been a mainstay of treatment for conditions like rheumatoid arthritis and Crohn's disease since the late 1990s. In 2020 alone, close to half a million people were prescribed Infliximab. It accounts for about 20% of biologic prescriptions specifically tailored towards immune system modulation therapies across multiple diseases. Unlike Xeljanz which can be taken orally at home, Remicade requires intravenous administration usually at a doctor’s office or infusion center every few weeks depending on the condition being treated and individual patient response.
Conclusion
Both Xeljanz (tofacitinib) and Remicade (infliximab) have solid track records of usage in patients with rheumatoid arthritis, psoriatic arthritis, and other inflammatory conditions. They are supported by numerous clinical studies indicating their efficacy over placebo treatments. While both drugs can be used simultaneously under careful physician supervision, they also have contraindications with each other due to their similar mechanisms of action as immunosuppressants.
Xeljanz works through inhibiting Janus kinases which play a key role in the immune response while Remicade targets TNF-alpha, one of the cytokines involved in systemic inflammation. Depending on patient needs and responses, either drug might be prescribed.
Remicade is usually considered a first-line biologic treatment option for these conditions whereas Xeljanz typically comes into play after failure or intolerance to methotrexate or anti-TNF therapy like Remicade.
While generic alternatives are available for both medications resulting in potential cost savings for patients who must pay out-of-pocket, insurance coverage may vary depending on individual plans.
For both drugs there's an adjustment period wherein full effects may not be immediately apparent. Side effect profiles differ somewhat between them; common side effects include increased risk of infections due to suppressed immunity but rare serious side effects such as malignancies and blood disorders exist too. Patients should closely monitor any changes or symptoms when starting treatment with either medication and seek medical help promptly if they experience severe side-effects.