CINDI----Enbrel (etanercept), Remicade (infliximab) & Humira (adalimumab) comparison

[Guest guest]

> Cindi,

> Here is an article posted a few months ago about the comparisons of the

> biologicals. I can¹t advise you which one is better, it is personal choice.

> Jennie made some very good points about the number of injections required, the

> mixing etc. I¹ve only ever been on Enbrel and since the needles are now much

> smaller, they don¹t bother me. What it comes down to is what is more

> effective. Hope this article helps:

>

> Dr. Paget

> Hospital for Special Surgery

> on TNF and the TNF blockers from

> " Rheumatoid Arthritis: A Patient's Reference (02/14/2003) " :

>

>

> TNF

>

> Tumor necrosis factor (TNF) blockers: TNF is a cytokine protein chemical

> that plays a critical role in inflammation. All three of the available

> TNF blockers have led to quantum clinical improvement over that obtained

> with methotrexate alone. Infections, such as tuberculosis, and other

> medical problems, such as low blood counts, have recently been reported.

> Monitoring with blood counts and TB skin tests is appropriate and should

> be guided by the physician. However, despite the necessity for caution

> and increased monitoring, the benefits of these drugs continue to

> outweigh their risks. You should discuss multiple issues, including

> effectiveness, safety, how the drug is given and your likelihood of

> using it as prescribed, as well as costs and your insurance coverage, as

> the choice of a TNF blocker is being made.

>

>

> ENBREL

>

> Etanercept (Enbrel): This fusion protein combines two p75 TNF receptors

> with an Fc receptor to form an immunoglobulin-looking molecule that

> decoys the pro-inflammatory cytokine TNF. By doing so, it decreases the

> binding of TNF to its cellular receptors and thus avoids the development

> of tissue inflammation and damage. It is both highly effective and, to

> date, safe. It not only leads to a clinical improvement over that

> obtained with MTX alone, but it has been shown to be disease-modifying.

> Infection risk is increased in those patients who have actively infected

> skin ulcers or diabetes. No increased risk of tumors or autoimmune

> disorders has been found. At this time, it is employed when patients

> have not had an excellent response to full-dose MTX. Etanercept is

> approved by the FDA for use with methotrexate, or may be used alone.

> Dose: 25 mg by subcutaneous injection twice weekly. (This is similar to

> the way people with diabetes give themselves shots for diabetes.) (See

> our Special Report on Postmarketing Adverse Event Data on TNF-alpha

> antagonists)

>

>

> REMICADE

>

> Infliximab (Remicade): This monoclonal molecule is composed of 3/4 human

> and 1/4 mouse proteins. It is an antibody to TNF itself. Thus, it binds

> TNF either in the blood or as it attaches to its receptor; by doing so,

> it stops pro-inflammatory and tissue damaging actions. Infliximab leads

> to both clinical improvement and a halting of erosion development and

> joint space narrowing. At this time, infliximab is approved only for use

> in combination with MTX. Rare cases of a lupus-like syndrome have been

> reported; patients improved following discontinuation of therapy and

> appropriate medical treatment. More than 80 cases of Mycobacterium

> tuberculosis have been reported worldwide in patients who have been

> treated with infliximab. The infection appears to occur soon after the

> institution of infliximab, and some patients have developed disseminated

> disease. Thus, a PPD (a test for TB) must be performed prior to starting

> infliximab; if the test is positive, a chest X-ray should be done. If

> the chest X-ray is normal, then infliximab can be used along with a

> nine-month course of isoniazid and Vitamin B6 to prevent serious TB.

> (See our Special Report on Postmarketing Adverse Event Data on TNF-alpha

> antagonists) To date, the reported infection and tumor risk is not

> greater in patients treated with infliximab than in RA patients not

> treated with this medication. Caution in infliximab use in patients with

> open skin ulcerations and/or diabetes would, however, be in order. Dose:

> The usual starting dosing schedule is an infusion at weeks 0, 2, 6 and

> then every 8 weeks. While the usual starting dose is 3 mg/kg in 250 cc

> of saline over 2 hours, in those patients who have not responded

> optimally this dose, it has been increased to 5 to10 mg/kg and the

> frequency of infusions to monthly or every six weeks.

>

>

> HUMIRA

>

> Adalimumab (Humira): Adalimumab is the first fully human anti-TNF-alpha

> monoclonal antibody. Therefore, it is less likely to spur your body to

> produce new antibodies, and it may have greater therapeutic potential

> than infliximab or etanercept. This is called " low immunogenicity " and

> it may help avoid the need for taking methotrexate at the same time -

> although using both drugs has been shown to yield efficacy benefits

> beyond those that might simply be additive. The preliminary data

> provided to the FDA suggest that adalimumab has an effectiveness and

> safety profile similar to etanercept. It has been approved both for

> reducing signs and symptoms of RA and inhibiting the progression of

> structural damage in adults with moderately to severely active disease

> who have had insufficient response to one or more DMARDs. As with the

> other two TNF inhibitors, your doctor will observe precautions for

> serious infections (including sepsis, tuberculosis, and fungal

> infections), demyelinating disease, and malignancies (including

> lymphoma), all of which also have been seen with adalimumab - although

> rarely. Since rheumatoid arthritis itself has been associated with an

> increased risk of lymphoma, the significance of the observed lymphoma

> cases is as yet not determined. Dose: Adalimumab offers a much more

> practical, patient-friendly dosing regimen than the other two TNF

> blockers. You will give yourself one subcutaneous injection of 40 mg

> every other week - again, similar to the way people with diabetes give

> themselves shots.

>

> http://rheumatology.hss.edu/pat/diseaseReviews/rheumArth/rheumArth_pat.asp

>

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