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Imuran vs Remicade
Introduction
For patients with autoimmune disorders or other inflammatory diseases, certain drugs that alter the immune system's behavior can help in managing symptoms and reducing inflammation. Imuran and Remicade are two such medications prescribed for these conditions. They each impact different aspects of the immune response, but both have anti-inflammatory effects in patients with autoimmune disorders. Imuran is an immunosuppressive medication, affecting lymphocyte function to reduce inflammation. On the other hand, Remicade is classified as a tumor necrosis factor (TNF) blocker; it inhibits the action of TNF-alpha, a substance in the body that causes inflammation and related symptoms.
Imuran vs Remicade Side By Side
| Attribute | Imuran | Remicade |
|---|---|---|
| Brand Name | Imuran | Remicade |
| Contraindications | Should not be taken if using live vaccines. Increased risk for developing certain types of cancer such as lymphoma. | Should not be taken if using live vaccines. Increased risk for developing certain types of cancer such as lymphoma. |
| Cost | For the brand name, around $1,200 for 100 tablets (50 mg). For the generic, azathioprine, costs as low as about $0.90 - $3 /day. | For the brand name, over $2,000 for an infusion bag (100 mg). Costs for generic infliximab vary widely depending on health insurance and hospital/clinic pricing. |
| Generic Name | Azathioprine | Infliximab |
| Most Serious Side Effect | Severe white blood cell reduction, liver damage, serious infections. | Signs of an allergic reaction, chest pain, shortness of breath, severe infections, liver problems, lupus-like syndrome. |
| Severe Drug Interactions | Live vaccines, potential negative interaction when used with other immunosuppressants. | Live vaccines, potential negative interaction when used with other immunosuppressants. |
| Typical Dose | 50-150 mg/day, starting dose usually 50 mg/day. | Initial dose of 3 mg/kg, can be adjusted based on response, not exceeding 10 mg/kg every six weeks. |
What is Imuran?
Azathioprine (the generic name for Imuran) was one of the first immunosuppressive drugs to be developed and it has been in use since the 1960s. Imuran works by reducing your body's natural immunity, effectively "dulling" your immune system from attacking itself, which can happen in certain diseases like rheumatoid arthritis or Crohn's disease. It is typically taken orally but can also be given via injection.
Infliximab (Remicade), on the other hand, is a more recent development in immunosuppression therapy having been approved by FDA in 1998. Unlike Azathioprine that broadly reduces the immune response, Infliximab specifically targets and blocks tumor necrosis factor alpha (TNF-alpha), a chemical messenger involved in systemic inflammation. This makes Remicade particularly effective at treating autoimmune diseases where inflammation is a major symptom such as rheumatoid arthritis and Crohn’s disease.
Both medications are potent suppressors of the immune system and therefore carry risks including serious infection. However, due to its targeted approach, Infliximab may have less overall side effects compared to Azathioprine.
What conditions is Imuran approved to treat?
Imuran and Remicade are both approved for the treatment of various autoimmune disorders:
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Imuran (azathioprine) is primarily used in conditions such as rheumatoid arthritis, systemic lupus erythematosus, inflammatory bowel disease including Crohn's disease and ulcerative colitis, dermatomyositis and polymyositis.
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Remicade (infliximab), on the other hand, is indicated for use in moderate to severe rheumatoid arthritis, psoriatic arthritis, plaque psoriasis, ankylosing spondylitis as well as moderate-to-severe forms of Crohn's disease and ulcerative colitis that have not responded adequately to conventional therapies.
How does Imuran help with these illnesses?
Imuran, also known as azathioprine, helps manage autoimmune diseases and conditions requiring organ transplantation by suppressing the immune system's response. It does this by inhibiting purine synthesis, which is essential for DNA replication. This results in decreased proliferation of cells involved in the immune response. Therefore, Imuran can limit the excessive or misdirected effects of the body’s immune system that occur in autoimmunity and organ rejection.
On the other hand, Remicade (infliximab) targets a specific part of the immune response - Tumor Necrosis Factor alpha (TNFα), a pro-inflammatory cytokine that plays a crucial role in promoting inflammation. By blocking TNFα, Remicade hinders its contribution to inflammatory processes and thus aids patients suffering from chronic inflammatory diseases like rheumatoid arthritis or Crohn's disease where TNFα plays an integral role.
Both medications aim to control overactive responses of our own defense mechanisms but do so through different pathways: while Imuran broadly suppresses cellular proliferation within all components of immunity, Remicade specifically zeroes-in on one key player driving inflammation.
What is Remicade?
Remicade, also known as infliximab, is a TNF alpha inhibitor which works by blocking the action of tumor necrosis factor-alpha (TNFα), a substance in the body that causes inflammation. It has been approved by FDA since 1998 and widely used to treat several autoimmune diseases such as rheumatoid arthritis, Crohn's disease, and ulcerative colitis.
Unlike Imuran (azathioprine), Remicade does not interfere with DNA synthesis but directly targets the inflammatory response. This means that its side-effect profile can be different from azathioprine. For instance, it does not cause nausea or affect liver function like azathioprine can. However, it may increase risk of serious infections due to its immunosuppressive effect.
The effects on TNFα make Remicade an effective treatment for many patients suffering from autoimmune conditions who do not respond well to traditional immunosuppressants like azathioprine.
What conditions is Remicade approved to treat?
Remicade has been approved by the FDA for treating a number of serious conditions, including:
- Rheumatoid arthritis
- Psoriatic arthritis
- Ankylosing spondylitis
- Crohn's disease in adults and children who haven't responded well to other medicines. Unlike Imuran, Remicade is also used for ulcerative colitis and plaque psoriasis, further expanding its application scope.
How does Remicade help with these illnesses?
Tumor Necrosis Factor (TNF) is a cell protein that plays an integral role in inflammatory and immune responses, including autoimmune diseases. In conditions such as rheumatoid arthritis or Crohn's disease, the body produces too much TNF causing excessive inflammation leading to tissue damage. Remicade works by binding to TNF and blocking its interaction with the cells it would usually cause inflammation in, thereby reducing symptoms of these conditions. It acts directly on this cellular communication pathway unlike Imuran which suppresses overall immune response more generally. Its direct action on TNF may prove beneficial for patients who do not respond well to broader immunosuppressants like Imuran, or it can be combined with these drugs for a more comprehensive treatment approach.
How effective are both Imuran and Remicade?
Both azathioprine (Imuran) and infliximab (Remicade) have approval from the FDA for treating certain autoimmune disorders, including Crohn's disease and rheumatoid arthritis. Imuran was approved in 1968 while Remicade received its initial approval in 1998, marking a significant difference in their historical usage.
Azathioprine is an immunosuppressive drug that decreases the immune response of the body to prevent it from attacking itself. Infliximab, on the other hand, is a monoclonal antibody that specifically targets and blocks tumor necrosis factor alpha (TNF-alpha), a substance made by cells of the immune system that can cause inflammation.
In terms of efficacy, both drugs have been shown to reduce symptoms associated with conditions like Crohn’s disease or rheumatoid arthritis. However, they are often used differently within treatment strategies. For instance, azathioprine might be used as a long-term maintenance therapy whereas infliximab could be utilized for acute flare-ups or severe cases due to its rapid onset action.
A 2010 study compared azathioprine against infliximab as maintenance treatments for Crohn's disease after corticosteroid induction therapy. The results showed comparable rates of clinical remission at one year between these two drugs but highlighted different safety profiles; Patients on infliximab were more likely to experience infusion reactions than those receiving azathioprine.
Research into each medication shows effective relief when managing autoimmune disorders such as rheumatoid arthritis or ulcerative colitis among others. Nevertheless, choosing between them will generally depend upon individual patient characteristics such as severity and stage of diseases along with potential side effects considerations.
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At what dose is Imuran typically prescribed?
Dosages of Imuran generally range from 50-150 mg/day, but research suggests that a starting dose of 50 mg/day is usually effective for treating various autoimmune diseases in most patients. Dosage can be adjusted based on the patient's weight and medical condition. Similarly, Remicade dosing varies depending on the specific disease being treated, typically ranging between 3-10 mg/kg administered intravenously every 4-8 weeks after an initial induction regimen. The dosage may be increased if there is insufficient response after several weeks to months of treatment. It's important to note that these medications should only be used under the direct supervision of a healthcare provider due to potential serious side effects.
At what dose is Remicade typically prescribed?
Remicade treatment is typically initiated with an initial dose of 3 mg per kg, administered by intravenous infusion. This dosage may then be increased or decreased based on the patient's response and tolerability, usually not exceeding a maximum of 10 mg/kg every six weeks. The infusions are given over a period of two hours and are spaced apart at zero (start), two, and six weeks after which it can be continued every eight weeks for chronic conditions like rheumatoid arthritis or Crohn's disease. It must also be noted that Remicade should always be used under the supervision of healthcare professionals experienced in the diagnosis and treatment of inflammatory disorders due to its complex dosing regimen.
What are the most common side effects for Imuran?
Common side effects of Imuran include:
- Nausea, vomiting
- Diarrhea
- Decreased appetite
- Hair loss
- Skin rash
- Weakness or fatigue
On the other hand, Remicade may cause these common side effects:
- Headache
- Abdominal pain
- Nausea and diarrhea
- Infusion reactions such as fever, chills, chest pain, low blood pressure or high blood pressure, shortness of breath, rash or itching.
It's important to note that both medications can have more serious side effects due to their impact on the immune system. Always consult with your healthcare provider if you experience any unusual symptoms while taking either medication.
Are there any potential serious side effects for Imuran?
While both Imuran and Remicade are used to manage inflammatory conditions, their side effects differ:
- Severe white blood cell reduction: This can increase vulnerability to infections. Signs include fever, sore throat, and fatigue.
- Allergic reactions: Symptoms may include hives, difficulty breathing, swelling in your face or throat.
- Vision changes: Look out for blurred vision or other visual disturbances as a sign of neurological issues.
- Heart problems: Rapid heart rate and shortness of breath could indicate cardiovascular complications.
- Low blood sodium levels - symptoms might be headache, confusion, slurred speech, severe weakness or vomiting.
- Serious infections – symptoms could include high fever; sweating; rapid heartbeat; stiffness in muscles; confusion; changes in pulse rate or blood pressure; dizziness leading up to fainting.
- Liver damage symptoms such as yellow eyes/skin (jaundice), dark urine If you experience any of these side effects while using either medication, seek immediate medical attention.
It's also important to note that both Imuran and Remicade have been associated with an increased risk of developing certain types of cancer. Always discuss this risk with your healthcare provider before starting treatment with these medications.
What are the most common side effects for Remicade?
Remicade, although highly effective for some conditions, can cause a variety of side effects that patients should be mindful of. These include:
- Respiratory issues like sore throat and stuffy nose
- Headache or dizziness
- Stomach-related problems such as nausea, stomach pain, loss of appetite or constipation
- Skin rashes
- Occasional sleep disturbances (insomnia)
- Sweating and feeling anxious or nervous
- Elevated heart rate
- Possible confusion or feelings of agitation
Moreover, in rare cases Remicade might lead to weight fluctuations and increased urination. Muscle or joint pain could also become an issue. Always remember to consult your healthcare provider if any unusual symptoms manifest after starting Remicade therapy.
Are there any potential serious side effects for Remicade?
While Remicade is generally well-tolerated, there are some rare but potentially serious side effects to be aware of:
- Signs of an allergic reaction such as hives, itching or skin rash, difficulty breathing, swelling in your face or throat
- Chest pain, shortness of breath and/or sudden weight gain
- Sudden numbness or weakness on one side of the body
- Severe headache with vision problems and balance issues
- Liver problems - upper stomach pain, loss of appetite, dark urine, jaundice (yellowing of the skin or eyes)
- Lupus-like syndrome - joint pain/swelling with fever accompanied by chest discomfort that worsens when you breathe deeply
If you experience any signs suggestive of these conditions while taking Remicade discontinue use immediately and seek emergency medical attention.
Contraindications for Imuran and Remicade?
Both Imuran and Remicade, along with many other immunosuppressant medications, may worsen symptoms in some individuals. If you notice an increase in infections or a decrease in your body's ability to fight off illnesses while on these drugs, please seek immediate medical attention.
Neither Imuran nor Remicade should be taken if you have been using live vaccines. Always tell your physician which medications or vaccines you are taking; live vaccines require a period of several weeks to clear from the system to prevent dangerous interactions with these immunosuppressive therapies.
There is also a potential risk for developing certain types of cancer such as lymphoma while on either drug. Ensure regular checkups and monitoring as directed by your healthcare provider while receiving treatment with either Imuran or Remicade.
How much do Imuran and Remicade cost?
For the brand name versions of these drugs:
- The price of 100 tablets of Imuran (50 mg) averages around $1,200 which works out to approximately $24/day at a dose of 200mg per day.
- The price for an infusion bag of Remicade (100 mg), used in hospital or clinic settings, can be over $2,000. As it is typically administered every six to eight weeks depending on your condition and body weight, this could work out to roughly $30–$45/day.
Thus if you are taking a higher dosage range for Imuran (i.e., 300 mg/day or higher), then brand-name Remicade might cost more on a per-day treatment basis. However, costs are significantly variable due to the administration method and patient-specific dosing regimen for Remicade. It's essential to understand that cost should not be the primary consideration in determining which drug is right for you; effectiveness and side effect profile are also important factors.
For the generic versions:
- Azathioprine (generic form of Imuran) is available in packs from 30 tablets upwards with average costs as low as about $0.90 - $3 /day based on typical doses between 150mg and 300mg daily.
- Infliximab (generic form of Remicade) costs are still generally high due to its complexity as a biologic medication even though they're lower than their branded counterpart. Costs vary widely depending on individual health insurance coverage and hospital/clinic pricing structures.
Popularity of Imuran and Remicade
Azathioprine, often branded as Imuran, is a well-established immunosuppressive medication that was estimated to have been prescribed to about 1.5 million people in the US in 2020. Azathioprine accounted for nearly 8% of prescriptions among drugs frequently used for autoimmune disorders like rheumatoid arthritis and inflammatory bowel disease. It has a long history of use and its prevalence has remained relatively steady over the past decade.
Infliximab, marketed under names such as Remicade, is another powerful immunosuppressant used primarily for severe cases of certain autoimmune conditions. In 2020, infliximab was prescribed to approximately 2 million patients in the USA. This accounts for around 13% of biologic prescriptions (drugs derived from living organisms) within this therapeutic area - making it one of the most commonly utilized medications within this class due to its efficacy across multiple conditions including Crohn’s disease and rheumatoid arthritis. However unlike azathioprine which can be taken orally at home, infliximab must be administered via infusion at a healthcare facility.
Conclusion
Both Imuran (azathioprine) and Remicade (infliximab) are effective treatments for inflammatory conditions such as rheumatoid arthritis, Crohn's disease, and ulcerative colitis. They work through differing mechanisms: Imuran suppresses the body's immune response by inhibiting purine synthesis necessary for DNA replication in cells of the immune system, while Remicade blocks a specific protein called tumor necrosis factor-alpha that plays a key role in triggering inflammation.
In some cases, these medications may be used together under careful supervision by your doctor, but they can also interact negatively with one another potentially leading to serious side effects. Due to their different modes of action and potential side effect profiles, they tend to be prescribed under varying circumstances.
Imuran is available in generic form which provides cost savings for patients paying out-of-pocket. It’s typically taken orally once or twice daily whereas Remicade requires intravenous infusion every 6-8 weeks after initial loading doses.
The most common adverse reactions associated with both drugs include nausea, vomiting, abdominal pain; however certain risks like infections or liver damage are higher with Remicade. For both medications, it is crucial that patients monitor any changes in symptoms and report them immediately to their healthcare provider due its potential impact on white blood cell count thereby affecting immunity.
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Refrences
- Su, C., & Lichtenstein, G. R. (2005, January). Are there predictors of Remicade treatment success or failure?. Advanced Drug Delivery Reviews. Elsevier BV.http://doi.org/10.1016/j.addr.2004.08.006
- Maini, S. R. (2004, May). Infliximab treatment of rheumatoid arthritis. Rheumatic Disease Clinics of North America. Elsevier BV.http://doi.org/10.1016/j.rdc.2004.01.009
- Nahra, V., Hasbani, G. E., Chaaya, M., & Uthman, I. (2020). The Use of Infliximab (Remicade®) for the Treatment of Rheumatic Diseases at a Tertiary Center in Lebanon: A 17-Year Retrospective Chart Review. Mediterranean Journal of Rheumatology. Convin SA.http://doi.org/10.31138/mjr.31.4.400