Remicade/Enbrel

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Here is another article I found on " about.com " ....Marilyn

Enbrel & Remicade: Side By Side

A comparison of the two anti-TNF therapies for rheumatoid arthritis

In 1998, Enbrel, the first of a new class of drugs for the treatment of

rheumatoid arthritis was FDA-approved. The new class of drugs was called

" anti-TNF " or anti-tumor necrosis factor. By 1999, Remicade, the second

drug in the anti-TNF class was FDA-approved. When Enbrel and Remicade were

first made available, a wave of excitement and new hope pervaded the

arthritis community. Patients, who had previously found little relief from

older drugs, were anxious to try the new biologic drugs. Doctors felt they

had something substantial to offer as a treatment option. It has now been

two years or more since some arthritis patients have tried one or both of

the anti-TNF drugs. How do the two drug compare?

Brand name Enbrel Remicade

Generic etanercept infliximab

Drug class anti-TNF anti-TNF

FDA Approved November 2, 1998 November 10 ,1999

ENBREL:Prescribed for rheumatoid arthritis, juvenile rheumatoid arthritis

REMICADE: rheumatoid arthritis, Crohn's disease

ENBREL: Dosage Adults usually self-inject 25mg twice weekly.

Children 4 to 17 years old, 0.4mg/kg (maximum 25mg) twice weekly. REMICADE:

Intravenously (given at doctor's office): 3 mg/kg as a single dose. The

initial dose should be followed by additional 3 mg/kg doses two and six

weeks after the first dose. The maintenance dose is 3 mg/kg every eight

weeks.

(Patients on Remicade usually take methotrexate also)

Common side effects of ENBREL:Injection site reactions, headache, dizziness,

nasal and throat irritation, increased risk of infection. Common side

effects of REMICADE: Upper respiratory tract

infections, urinary tract infections, cough, rash, back pain, nausea,

vomiting, abdominal pain, headache, weakness and fever.

Allergic reaction to REMICADE may include low or high blood pressure, chest

pain, difficulty breathing, rash, itching, fever and chills.

Food interaction & Drug Interactions ENBREL: None known, REMICADE: None

known

What is it and how does it work?

Cytokines are chemical messengers between cells which play a role in

maintaining good health, but also can cause problems if uncontrolled. At

least 24 different cytokines exist which are involved in the destruction of

rheumatoid arthritis. Researchers have found that one of the cytokines

involved in the inflammation pathway of rheumatoid arthritis is tumor

necrosis factor-alpha, TNF-alpha.

The biologic drug Enbrel is a man-made protein, similar to a protein found

naturally in the body. Enbrel works by capturing or " soaking up " TNF and

interrupting the process that can lead to the symptoms of RA. The effects of

Enbrel last up to four to five days. Enbrel is a fused protein made from

human components.

Remicade is not totally made from human proteins as is Enbrel. Remicade is

a combination of mouse and human substances, and is a monoclonal antibody.

Remicade neutralizes the biologic activity of TNF-alpha by binding to it.

The effects of Remicade last for the 8-week period between infusions.

With Enbrel there may be up to a 3% incidence of antibodies formed. With

Remicade, antibody formation has been more of a problem in up to 13% of

cases. By using methotrexate together with Remicade, the problem of antibody

formation is diminished.

Precautions:

Because tumor necrosis factor (TNF) plays a key role in the response of the

immune system to infections, it is possible that the action of blocking TNF

may worsen or increase the occurrence of

infections. Patients with serious infections should not receive anti-TNF

drugs. If a serious infection develops during the course of treatment with

anti-TNF drugs, the drug should be discontinued.

Enbrel is not recommended for patients with preexisting disease of the

central nervous system or for those with multiple sclerosis, myelitis, or

optic neuritis.

Full prescribing info and contraindications can be found on their websites,

www.enbrel.com and www.remicade-ra.com

Cost & Insurance Coverage:

The new biologic drugs are expensive. Since Remicade is given as an

infusion in either a doctor's office or hospital setting it is classified as

a " treatment " . Enbrel is self-injected and classified as a " prescription

drug " . Due to the variance in how they are classified, the insurance

coverage of the two medications is not the same. Medicare and Medicare

supplement plans will cover Remicade, but will not cover Enbrel since there

still is no prescription drug plan for Medicare recipients.

When Enbrel was first approved, the cost was quoted as $220/week, or between

$11,000-$12,000/year. The average wholesale price of Remicade is $611.33

per vial. The average RA patient will require two to three vials per

infusion, and receive about 6 treatments per year following the initial dose

period at 0, 2, and 6 weeks. There is also additional cost involved with

Remicade to pay for the personnel and treatment facility required to

administer the infusion.

Is it for you?

For rheumatoid arthritis patients whose symptoms come largely from rampant

TNF-alpha, Enbrel or Remicade can work miraculously. By controlling the

biological activity of TNF-alpha, these drugs are capable of controlling the

activity of the disease. The drugs generally work rapidly and patients who

respond well usually feel better within a couple of weeks.

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