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Enbrel vs Xeljanz
Introduction
For patients diagnosed with rheumatoid arthritis or other autoimmune diseases, certain drugs that reduce the immune system's attack on its own cells can help in managing pain, inflammation and slowing disease progression. Enbrel and Xeljanz are two such medications commonly prescribed for these conditions. They each interact differently within the body but both aim to decrease the activity of an overactive immune system. Enbrel is a tumor necrosis factor inhibitor (TNFi) which blocks the action of TNF, a substance in the body that causes inflammation. On the other hand, Xeljanz falls under Janus kinase inhibitors category which works by blocking one or more of a specific family of enzymes (JAKs), interfering with inflammatory processes within your body.
Enbrel vs Xeljanz Side By Side
| Attribute | Enbrel | Xeljanz |
|---|---|---|
| Brand Name | Enbrel | Xeljanz |
| Contraindications | Cannot be taken if currently using biologic drugs or immunosuppressants, or live vaccines. | Cannot be taken if currently using biologic drugs or immunosuppressants, or live vaccines. |
| Cost | $5,400 for a one month supply (4 doses) | $4,800 for a bottle of 60 tablets (5 mg) |
| Generic Name | Etanercept | Tofacitinib |
| Most Serious Side Effect | Infections, Hepatitis B reactivation, Lymphoma and other malignancies | Signs of an allergic reaction, Liver problems, Low blood cell counts, New skin sores, Rapid weight gain with swelling |
| Severe Drug Interactions | Live vaccines, other biologic drugs or immunosuppressants | Live vaccines, other biologic drugs or immunosuppressants |
| Typical Dose | 25-50 mg per week | 5 mg twice daily |
What is Enbrel?
Etanercept (the generic name for Enbrel) was one of the first drugs in a class of therapeutics known as TNF inhibitors, which represented a major progression from previous treatments for rheumatic conditions. Etanercept, approved by the FDA in 1998, works by binding to and inhibiting tumor necrosis factor-alpha (TNFα), an inflammatory mediator overproduced in certain autoimmune diseases. This effectively reduces inflammation and associated symptoms. It's often prescribed for various forms of arthritis and psoriasis.
In contrast, Tofacitinib (the generic name for Xeljanz) belongs to a newer class of disease-modifying antirheumatic drugs known as JAK inhibitors. Approved by the FDA in 2012, this oral medication blocks Janus kinases–enzymes that play a vital role in immune cell activation–thereby mitigating inflammation caused due to these cells.
Both medications have different side effect profiles influenced by their mechanisms of action; hence patients should discuss these factors with their healthcare provider before making a choice between them.
What conditions is Enbrel approved to treat?
Enbrel is approved for the treatment of various autoimmune diseases:
- Rheumatoid arthritis, a chronic inflammatory disorder affecting many joints, including those in the hands and feet
- Psoriatic arthritis (often used in combination with methotrexate), which causes joint pain, stiffness and swelling.
- Ankylosing spondylitis, a type of arthritis that affects the spine.
- Plaque psoriasis in patients who are candidates for systemic therapy or phototherapy.
Xeljanz too is employed to treat similar conditions but also includes Ulcerative Colitis - an inflammatory bowel disease that causes long-lasting inflammation and ulcers (sores) in your digestive tract.
How does Enbrel help with these illnesses?
Enbrel helps manage autoimmune diseases like rheumatoid arthritis by reducing the amount of tumor necrosis factor (TNF) in the body. TNF is a protein produced by your immune system that, when overproduced, can cause inflammation and damage to bones, cartilage and tissue. Enbrel works as a TNF inhibitor; it binds to TNF molecules and blocks them from interacting with cells in your body, hence decreasing inflammatory response. This is significant because inflammation plays an important role in many autoimmune conditions including joint pain and swelling amongst other things. It's thought that individuals with certain autoimmune conditions have relatively higher levels of TNF. Therefore, by reducing this protein's interaction with the body's cells, Enbrel can limit the negative effects associated with these conditions helping patients manage their symptoms effectively.
What is Xeljanz?
Xeljanz, also known as tofacitinib, is a type of drug called a Janus kinase (JAK) inhibitor. It works by blocking the action of enzymes called Janus kinases in immune cells — this reduces inflammation and damage in joints. Tofacitinib was first approved by the FDA in 2012 for use in rheumatoid arthritis patients who have not responded well to methotrexate.
As Xeljanz is not an anti-TNF medication like Enbrel, it does not work by directly binding and inhibiting tumor necrosis factor (TNF). This difference means that its side-effect profile can be different from that of anti-TNF drugs such as Enbrel. Specifically, while it can still cause infections and other serious side effects similar to those caused by Enbrel, it may result in fewer injection site reactions since it's taken orally.
The effect on Janus kinases makes Xeljanz potentially beneficial for treating several autoimmune conditions including psoriatic arthritis and ulcerative colitis– especially among patients who do not respond well or cannot tolerate traditional biologic medications such as Enbrel.
What conditions is Xeljanz approved to treat?
Xeljanz is a medication approved by the Food and Drug Administration (FDA) for treating:
- Rheumatoid arthritis, an autoimmune disease that primarily affects joints
- Psoriatic arthritis, another type of inflammatory joint condition related to psoriasis
- Ulcerative colitis, a chronic inflammatory bowel disease characterized by inflammation in the digestive tract.
How does Xeljanz help with these illnesses?
JAK inhibitors like Xeljanz are a newer class of medications that work by blocking the action of Janus kinases, enzymes which play a key role in the immune response and inflammation. By inhibiting these enzymes, Xeljanz helps to reduce the symptoms associated with conditions such as rheumatoid arthritis, psoriatic arthritis and ulcerative colitis. Unlike Enbrel, which is administered through subcutaneous injection once or twice weekly, Xeljanz comes in pill form making it more convenient for many patients. Additionally, because it acts on different pathways than traditional TNF inhibitors like Enbrel, it may be an effective option for patients who don't respond well to those medications or can't tolerate their side effects.
How effective are both Enbrel and Xeljanz?
Both etanercept (Enbrel) and tofacitinib (Xeljanz) have established track records in managing symptoms of rheumatoid arthritis, with their FDA approvals coming 14 years apart. Since they act on different pathways involved in inflammation, they may be chosen under different circumstances. The ability of etanercept and tofacitinib in alleviating arthritis was directly studied in a double-blind clinical trial; the two drugs demonstrated similar efficacy at reducing disease activity as well as comparable safety profiles.
A 2011 meta-analysis showed that Enbrel is effective at reducing symptoms within the first week of treatment, has an acceptable side effect profile compared with other treatments for rheumatoid arthritis, and is generally well-tolerated even by patients who cannot tolerate methotrexate. As one of the first TNF inhibitors approved for use, it has a long history and considerable research behind its effectiveness.
In contrast, a 2017 review indicated that Xeljanz seems more effective than placebo in treating rheumatoid arthritis and appears similar in efficacy to other common treatments like biological DMARDs. However, due to its relatively recent approval (in comparison), data confirming its stand-alone efficacy are not quite as robust as those for Enbrel. Nonetheless, due to its unique mode of action - targeting Janus kinases rather than TNF – Xeljanz may be an optimal choice for patients who did not respond adequately or had adverse effects from biologic DMARDs such as anti-TNF agents.
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At what dose is Enbrel typically prescribed?
Administered dosages of Enbrel typically range from 25-50 mg per week, depending on the specific condition being treated. For most adults with rheumatoid arthritis, psoriatic arthritis, or ankylosing spondylitis, a dose of 50 mg per week is common. Children with juvenile idiopathic arthritis usually start at a dosage calculated by body weight. On the other hand, Xeljanz can be taken orally at a typical dose of 5mg twice daily for those suffering from conditions like rheumatoid or psoriatic arthritis. Dosage may be adjusted based on patient response and tolerance after several weeks but should not exceed 11mg in any given day.
At what dose is Xeljanz typically prescribed?
Xeljanz treatment is commonly initiated at a dosage of 5 mg twice daily, equating to a total daily dose of 10 mg. This administration can be adjusted based on the patient's individual response and tolerability. For certain conditions like ulcerative colitis, the initiation dose might be higher, typically at 10mg taken twice daily for about eight weeks, then reduced to the standard 5 mg twice daily regimen. It's crucial that Xeljanz therapy is closely monitored by healthcare professionals due to its potential side effects and interactions with other drugs or medical conditions. Therefore, it should not exceed the maximum recommended dosage unless explicitly advised by your physician after several weeks if there are no improvements in symptoms.
What are the most common side effects for Enbrel?
Common side effects for Enbrel and Xeljanz, two drugs used to treat rheumatoid arthritis, can vary.
Enbrel's potential side effects include:
- Infections (such as upper respiratory infections)
- Injection site reactions
- Headache
- Dizziness
- Rash
On the other hand, Xeljanz might cause:
- Upper respiratory tract infection
- Diarrhea
- Nasopharyngitis (inflammation of the throat and nasal passages)
- Hypertension (high blood pressure)
- Headache
Remember that everyone's body responds differently to medication. It is important to discuss these potential side effects with your healthcare provider before starting treatment.
Are there any potential serious side effects for Enbrel?
While both Enbrel and Xeljanz are used to treat conditions like rheumatoid arthritis, they do carry different potential side effects. For instance:
- Severe allergic reactions: Symptoms may include hives, difficulty breathing or swallowing, facial swelling, chest tightness.
- Unusual bleeding or bruising: This might be a sign of low blood platelets and could result in serious health issues if not treated promptly.
- Infections: Both medications can increase your risk of getting infections. Seek immediate medical attention if you notice signs such as fever, persistent sore throat or coughing up mucus/blood.
- Hepatitis B reactivation in people who carry the virus: Symptoms include dark urine coloration, extreme fatigue or weakness, loss of appetite accompanied by abdominal pain on the right side beneath the lower ribs.
- Lymphoma and other malignancies: Some patients taking these drugs have developed certain types of cancer; hence regular check-ups are essential for early detection.
It's also important to note that while rare with both medications individually - symptoms of nervous system complications such as mood changes, confusion and muscle weakness should never be ignored. Always consult your healthcare provider immediately upon experiencing any adverse reactions.
What are the most common side effects for Xeljanz?
The usage of Xeljanz, similar to other medications, may result in certain side effects. These can include:
- Headache and dizziness
- Nasal congestion, sore throat or changes in your sense of taste
- Nausea or stomach upset
- Diarrhea
- Increased sweating
- Weight loss
- Rash or itching skin
- Tiredness and trouble sleeping (insomnia) Additionally, more serious but less common side effects such as fast heartbeat or increased blood pressure could occur. In rare cases, symptoms like confusion and hostility have also been reported. As with any medication, it's important to monitor your body's reactions closely while taking Xeljanz.
Are there any potential serious side effects for Xeljanz?
Xeljanz, while effective for treating conditions like rheumatoid arthritis and psoriasis, may also have serious side effects in some cases. It's essential to be aware of potential symptoms which include:
- Signs of an allergic reaction such as hives; difficulty breathing; swelling of your face, lips, tongue or throat
- Unusual changes in mood or behavior
- Symptoms resembling a stroke: sudden numbness or weakness on one side of the body, slurred speech, feeling short of breath
- Liver problems: nausea, upper stomach pain, itching/tiredness/loss of appetite/dark urine/clay-colored stools/jaundice (yellowing of the skin or eyes)
- Low blood cell counts causing pale skin/feeling light-headed/rapid heart rate/trouble concentrating
- New skin sores
- Rapid weight gain with swelling
If you experience any such reactions after taking Xeljanz consult your healthcare provider immediately.
Contraindications for Enbrel and Xeljanz?
Both Enbrel and Xeljanz, in addition to most other rheumatoid arthritis medications, may exacerbate symptoms of infection in some people. If you notice an increase in symptoms such as fever, fatigue, cough or sores that do not heal, please seek immediate medical attention.
Neither Enbrel nor Xeljanz can be taken if you are currently taking biologic drugs or immunosuppressants. Always inform your doctor about the medications you are using; these will require a period of time to clear from your system to prevent dangerous interactions with Enbrel and Xeljanz. For example, live vaccines should not be given while receiving treatment with either drug due to potential interference with immune response.
How much do Enbrel and Xeljanz cost?
For the brand-name versions of these drugs:
- The price of a typical one month supply (4 doses) of Enbrel (50 mg/ml pre-filled syringes) averages around $5,400. This works out to be approximately $180 per day.
- The cost for a bottle of 60 tablets Xeljanz (5 mg), which is roughly a month's supply, averages about $4,800 or approximately $160 per day.
Thus, if you are using these treatments as directed by your healthcare provider, then brand-name Xeljanz is less expensive on a per-day treatment basis compared to Enbrel. However, it’s crucial to note that cost should not be the primary factor in determining which medication best suits your condition.
As for generic versions:
- Etanercept (the active ingredient in Enbrel) currently does not have an FDA-approved biosimilar available in the U.S.
- Tofacitinib (the active ingredient in Xeljanz) also does not have an approved generic version at present.
Therefore costs remain high for both medications relative to other drug categories with available generics.
Popularity of Enbrel and Xeljanz
Etanercept, commonly known by the brand name Enbrel, was prescribed to about 500,000 people in the US in 2020. As a tumor necrosis factor (TNF) inhibitor, it is primarily used for autoimmune diseases such as rheumatoid arthritis and psoriasis. Etanercept accounts for about 22% of TNF-inhibitor prescriptions in the US.
Tofacitinib goes by the brand name Xeljanz and was prescribed to approximately 200,000 individuals within the USA during that same year. It's classified as a JAK inhibitor and is also utilized in treating similar conditions like rheumatoid arthritis but has additional indications including ulcerative colitis. Tofacitinib represents around 10% of JAK-inhibitor prescriptions across America.
While both medications have been relatively steady over recent years regarding their prevalence, newer classes of drugs are emerging providing patients with more treatment options leading to gradual changes in prescription statistics.
Conclusion
Both Enbrel (etanercept) and Xeljanz (tofacitinib) have established records of usage in patients with autoimmune diseases such as rheumatoid arthritis, psoriasis, and inflammatory bowel disease. They are supported by numerous clinical trials demonstrating they are more effective than placebo treatments. Both drugs might be used together under certain circumstances; however, this would require careful evaluation by a physician due to potential increased risk of infections or other side effects. Their different mechanisms of action – Enbrel acting primarily by blocking the activity of tumor necrosis factor-alpha (TNF-alpha), and Xeljanz inhibiting Janus kinases, enzymes involved in inflammation process – make them suitable for different situations.
Enbrel is typically considered a first-line biologic option, while Xeljanz is usually prescribed when patients do not respond well to TNF inhibitors like Enbrel or if there's a need to avoid drug injections since it's taken orally.
While both drugs can offer substantial relief from symptoms associated with these conditions, an adjustment period may be necessary before results are seen.
Regarding side effects profile: both medications generally have similar safety profiles but come with risks including serious infections and possibly cancer. Patients must closely monitor their health status especially when starting treatment and should seek medical help immediately if they experience unusual symptoms suggesting infection or other adverse reactions.
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Refrences
- Scott, L. J. (2014, July 18). Etanercept: A Review of Its Use in Autoimmune Inflammatory Diseases. Drugs. Springer Science and Business Media LLC.http://doi.org/10.1007/s40265-014-0258-9
- Lam, S. (2016). JAK inhibitors: A broadening approach in rheumatoid arthritis. Drugs of Today. Portico.http://doi.org/10.1358/dot.2016.52.8.2543995
- Culy, C. R., & Keating, G. M. (2003). Spotlight on Etanercept in Rheumatoid Arthritis, Psoriatic Arthritis and Juvenile Rheumatoid Arthritis*. BioDrugs. Springer Science and Business Media LLC.http://doi.org/10.2165/00063030-200317020-00006
- Chen, D.-Y., Chou, S.-J., Hsieh, T.-Y., Chen, Y.-H., Chen, H.-H., Hsieh, C.-W., & Lan, J.-L. (2009, April). Randomized, Double-blind, Placebo-controlled, Comparative Study of Human Anti-TNF Antibody Adalimumab in Combination with Methotrexate and Methotrexate Alone in Taiwanese Patients with Active Rheumatoid Arthritis. Journal of the Formosan Medical Association. Elsevier BV.http://doi.org/10.1016/s0929-6646(09)60071-1
- Scott, L. J. (2013, May 29). Tofacitinib: A Review of its Use in Adult Patients with Rheumatoid Arthritis. Drugs. Springer Science and Business Media LLC.http://doi.org/10.1007/s40265-013-0065-8
- Paik, J., & Deeks, E. D. (2019, March 20). Tofacitinib: A Review in Psoriatic Arthritis. Drugs. Springer Science and Business Media LLC.http://doi.org/10.1007/s40265-019-01091-3