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Orencia vs Actemra
Introduction
For patients with rheumatoid arthritis (RA) or other types of autoimmune disorders, certain drugs can help in managing symptoms by targeting specific aspects of the immune system. Orencia and Actemra are two such medications that are prescribed for these conditions. They each impact different proteins involved in the inflammatory process associated with RA, but both have symptom-managing effects for patients.
Orencia is a selective T-cell costimulation modulator; it works by inhibiting the activation of T-cells, which play a crucial role in causing inflammation and joint damage. On the other hand, Actemra is classified as an interleukin-6 (IL-6) receptor antagonist; IL-6 is a protein produced by various cells during infection or after trauma to tissue and has been found to be elevated in people with RA. By blocking this protein, Actemra helps reduce inflammation.
Orencia vs Actemra Side By Side
| Attribute | Orencia | Actemra |
|---|---|---|
| Brand Name | Orencia | Actemra |
| Contraindications | Should not be taken if undergoing treatment with any kind of biological therapy for rheumatoid arthritis. Not to receive live vaccines. | Should not be taken if undergoing treatment with any kind of biological therapy for rheumatoid arthritis. Not to receive live vaccines. |
| Cost | Around $5000 for a 125 mg/1 ml pre-filled syringe pack (4 syringes) | Approximately $5400 for Actemra 162mg/0.9ml subcutaneous solution (2 pens) |
| Generic Name | Abatacept | Tocilizumab |
| Most Serious Side Effect | Signs of serious infection, allergic reactions, nervous system problems, heart issues, symptoms of blood disorders. | Severe allergic reaction or skin reaction, liver problems, digestive issues indicating pancreatitis, shortness of breath, heart failure, unusual bleeding or bruising. |
| Severe Drug Interactions | Biological therapies due to potential interactions leading to severe side effects. | Biological therapies due to potential interactions leading to severe side effects. |
| Typical Dose | 500 mg-1g intravenously at 0, 2, and 4 weeks initially then every four weeks thereafter for adults. Children's dosage determined by weight. | 4 mg/kg once every four weeks through intravenous infusion, can be increased to 8 mg/kg every four weeks depending on response and tolerance. |
What is Orencia?
Abatacept (the generic name for Orencia) was a significant advancement in the class of drugs known as selective immunosuppressants, which are used to treat autoimmune conditions such as rheumatoid arthritis. It first received FDA approval in 2005. Orencia works by suppressing the immune system's overactive response, effectively "calming" it and reducing inflammation and pain. This drug is generally prescribed when other treatments have proven ineffective.
On the other hand, Tocilizumab (Actemra) belongs to another class of medications called interleukin-6 (IL-6) receptor antagonists. Approved by the FDA in 2010, Actemra also inhibits an overactive immune response but does so by blocking IL-6 activity specifically.
While both drugs have similar uses and side effects—such as increased risk of serious infections due to suppressed immunity—there may be differences in their effectiveness depending on individual patient factors. Therefore, one might be preferred over the other based on a healthcare provider's judgment.
What conditions is Orencia approved to treat?
Orencia is approved for the treatment of a variety of rheumatologic conditions, including:
- Rheumatoid arthritis (RA), both as monotherapy and in combination with methotrexate
- Juvenile idiopathic arthritis (JIA) in patients aged 2 years and older
- Psoriatic arthritis (PsA), for use as monotherapy or in combination with methotrexate.
How does Orencia help with these illnesses?
Orencia (abatacept) helps to manage rheumatoid arthritis by modulating the overactive immune response involved in this condition. It does this by binding to a specific type of cell called T-cells, effectively blocking their communication with other parts of the immune system that trigger inflammation and damage in joints. This ability to interfere with the 'conversation' between these cells reduces both inflammation and joint damage associated with rheumatoid arthritis.
On the other hand, Actemra (tocilizumab) works differently but is also used for managing rheumatoid arthritis. Rather than targeting T-cells like Orencia, it blocks a substance known as interleukin-6 (IL-6), which plays a crucial role in triggering inflammatory responses when levels are too high.
Therefore, both Orencia and Actemra can limit the negative effects of an overactive immune response seen in rheumatoid arthritis, helping patients manage their symptoms and prevent further joint damage; though they achieve this through different mechanisms.
What is Actemra?
Actemra, known generically as tocilizumab, is an interleukin-6 (IL-6) receptor antagonist. This means it works by blocking the action of IL-6, a protein in the body that causes inflammation. It was first approved by the FDA in 2010 for treatment of rheumatoid arthritis when other medications have not worked or cannot be used. Unlike Orencia, which targets T-cells to reduce their activation and thus decrease inflammation, Actemra directly targets and reduces inflammatory signals sent out through IL-6 receptors.
This unique mechanism of action might make Actemra more suitable for certain patients who do not respond well to traditional treatments such as those involving TNF inhibitors or T-cell modulators like Orencia. Side effects can vary but are less likely to involve issues related to immune suppression since it does not primarily target essential immune cells like T-cells.
What conditions is Actemra approved to treat?
Actemra is an interleukin-6 (IL-6) receptor antagonist, approved for the treatment of several conditions:
- Moderate to severe rheumatoid arthritis in adults
- Active systemic juvenile idiopathic arthritis in patients two years of age and older
- Giant cell arteritis in adults It's also the first FDA-approved treatment for chimeric antigen receptor (CAR) T cell-induced severe or life-threatening cytokine release syndrome.
How does Actemra help with these illnesses?
Interleukin 6 is a cytokine that plays an important role in immune response, inflammation and infection responses. It has been implicated in several autoimmune diseases such as rheumatoid arthritis. Actemra works by blocking the action of interleukin 6, thereby reducing symptoms of these conditions. Its influence on other cytokines may also contribute to its effectiveness as a treatment for autoimmune disorders. Unlike Orencia which targets T-cell activation, Actemra directly inhibits the effects of Interleukin-6 (IL-6), providing another unique pathway for physicians to manage their patients' condition more effectively when they do not respond well to other treatments or have contraindications with them.
How effective are both Orencia and Actemra?
Both abatacept (Orencia) and tocilizumab (Actemra) have established histories of success in treating patients with rheumatoid arthritis, and they were initially approved by the FDA within a few years of each other. Since they act on different aspects of the immune system, they may be prescribed under different circumstances. The effectiveness of abatacept and tocilizumab in alleviating symptoms of rheumatoid arthritis was directly studied in a double-blind clinical trial; both drugs exhibited similar efficacy in managing disease progression as well as similar safety profiles.
A 2008 review reported that abatacept is effective at reducing symptoms starting from the first month of treatment, has an acceptable side effect profile compared to many other disease-modifying antirheumatic drugs (DMARDs), and is generally well-tolerated even among older populations. Further research indicates that while it's not typically used as a first-line treatment option due to cost considerations, its unique mechanism can make it beneficial for patients who did not respond adequately to conventional treatments such as methotrexate or TNF inhibitors.
On the other hand, a 2016 meta-analysis indicated that tocilizumab seems more effective than placebo at relieving signs and symptoms of rheumatoid arthritis, demonstrating comparable efficacy to TNF inhibitors. While concerns about elevated cholesterol levels exist with Actemra use, this drug presents an alternative solution especially for those intolerant or unresponsive to traditional DMARDS or anti-TNF agents.
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At what dose is Orencia typically prescribed?
Dosages of Orencia and Actemra are dependent on the patient's weight, health condition, and response to treatment. For Orencia, adults may receive 500 mg-1g intravenously at 0, 2, and 4 weeks initially then every four weeks thereafter. Children's dosage is determined by their weight. On the other hand, Actemra dosages range from 4–8 mg/kg every four weeks for adults with rheumatoid arthritis based on clinical considerations. Dosage can be increased after a few administrations if there is no observed response but should not exceed the maximum limit of 800mg per infusion in any case.
At what dose is Actemra typically prescribed?
Actemra therapy typically begins with a dosage of 4 mg/kg once every four weeks through intravenous infusion. Depending on the patient's response and tolerance, the dose can be increased to 8 mg/kg every four weeks. For adult patients with Giant Cell Arteritis (GCA), Actemra is administered as a subcutaneous injection at a dose of 162 mg once weekly. The maximum recommended dose is 800mg per infusion for adults, which may be considered if there is no significant improvement in symptoms after multiple treatments at lower doses. As always, dosing adjustments should only be made under the guidance of a healthcare provider.
What are the most common side effects for Orencia?
Common side effects of Orencia may include:
- Headache
- Dizziness
- Nausea, upset stomach
- Mild skin rash or itching
- Cold symptoms such as stuffy nose, sneezing, sore throat
On the other hand, Actemra can cause:
- Upper respiratory tract infections (like common cold and sinus infections)
- Headache
- High blood pressure -Nausea -Diarrhea
It's important to note that both medications have more serious potential side effects like severe allergic reactions, liver problem signs (such as dark urine), lung problems (trouble breathing), or infection symptoms. Always consult your healthcare provider if you experience any unusual symptoms while taking these medications.
Are there any potential serious side effects for Orencia?
In rare cases, Orencia can cause potentially severe side effects such as:
- Signs of serious infection include fever, chills, aching muscles or joints, extreme fatigue and confusion.
- Allergic reactions may manifest through hives; difficulty breathing; swelling in your face or throat.
- Some patients might experience nervous system problems: weakness on one side of the body, changes in vision like blurred vision or tunnel vision, difficulty with speech.
- Heart issues might present fast or irregular heartbeats accompanied by breathlessness and sudden dizziness.
- Symptoms of blood disorders could occur - unusual bleeding or bruising (nosebleeds, bleeding gums), low red/white blood cell count causing sudden onset paleness and fatigue.
These are not common occurrences but if you notice any symptoms that make you feel unwell while taking Orencia stop the medication immediately and seek medical help. As these drugs affect your immune system there is also a risk for reactivation of hepatitis B virus if you are a carrier. It is important to inform your doctor about any history related to this before starting treatment.
What are the most common side effects for Actemra?
Actemra, unlike Orencia, has its own set of potential side effects. Here are some that might be experienced:
- Mild stomach discomfort or nausea
- Headache and dizziness
- Runny or stuffy nose and sore throat
- Itching or skin rash
- Increased blood pressure
- Nervousness and anxiety
- Muscle pain or joint stiffness Tremors aren't typically associated with Actemra use but keep in mind this isn't an exhaustive list. If you have any rare symptoms like blurred vision, confusion, agitation, hostility, severe gastrointestinal issues (vomiting/loss of appetite), sleep problems (insomnia), weight loss or increased urination while using Actemra, it is crucial to consult your healthcare provider immediately.
Are there any potential serious side effects for Actemra?
While Actemra is generally well-tolerated, it can in some cases cause serious side effects. These may include:
- Signs of a severe allergic reaction or skin reaction: hives, itching, fever, swollen glands, difficulty breathing or swallowing; swelling in your face or throat; sore throat; burning eyes; skin pain; red or purple skin rash with blistering and peeling
- Liver problems: signs may include yellowing of the eyes and skin (jaundice), dark urine coloration, stomach discomfort on the right upper side
- Digestive issues like severe stomach pain which could indicate pancreatitis
- Shortness of breath
- Swelling around ankles or sudden weight gain which might be indicative of heart failure
- Unusual bleeding or bruising susceptibility as this might suggest low platelet count
If you experience any such symptoms while taking Actemra immediately discontinue its use and consult with your healthcare provider.
Contraindications for Orencia and Actemra?
Both Orencia and Actemra, along with most other immunosuppressant medications, may worsen symptoms of infections in some people. If you notice an increase in the severity or frequency of infections, please seek immediate medical attention.
Neither Orencia nor Actemra should be taken if you're undergoing treatment with any kind of biological therapy for rheumatoid arthritis due to potential interactions that could lead to severe side effects. Always tell your physician which medications you are taking; biological therapies will require a period of about 2 weeks to clear from the system to prevent dangerous interactions with Orencia and Actemra.
Moreover, both these drugs can potentially cause serious liver problems. Regular monitoring is required so that any adverse effects can be detected early. Also remember that it's essential not to receive live vaccines while using either medication because they decrease the immune response making vaccinations less effective and increasing the risk for contracting diseases.
How much do Orencia and Actemra cost?
For the brand-name versions of these drugs:
- The price of a 125 mg/1 ml pre-filled syringe pack (4 syringes) of Orencia averages around $5000, which works out to about $250 per day when taken weekly.
- The price of Actemra 162mg/0.9ml subcutaneous solution (2 pens) is approximately $5400, working out to roughly $270 per week if used once weekly.
Thus, if you are using this dosage range for both biologics, then brand name Orencia would be less expensive on a per-week treatment basis. Please note that cost should not be a primary consideration in determining which drug is right for you as each person's response varies and your medical professional will prescribe based on your specific condition and needs.
Currently there are no generic versions available for either Orencia or Actemra due to their complex biological nature. As such costs remain high; however patient assistance programs may help offset some costs depending upon individual eligibility criteria.
Popularity of Orencia and Actemra
Orencia, also known by its generic name abatacept, is a medication used for the treatment of rheumatoid arthritis and juvenile idiopathic arthritis. In 2020, it was prescribed to about 1% of individuals with rheumatoid arthritis in the United States. Orencia works by inhibiting T cells activation - an important part of your immune response.
Actemra (tocilizumab) is another drug commonly used in the treatment of moderate-to-severe rheumatoid arthritis and has been gaining recognition as a powerful agent against cytokine release syndrome associated with severe COVID-19. The number of patients receiving Actemra increased significantly during 2020 due to this versatility, although precise figures are not yet available.
Both Orencia and Actemra have unique mechanisms of action that provide options beyond traditional disease-modifying antirheumatic drugs (DMARDs), which can be particularly beneficial for those who fail to respond adequately or are unable to tolerate these more common treatments. However, they should only be given under specialist supervision due to potential side effects including serious infections.
Conclusion
Both Orencia (abatacept) and Actemra (tocilizumab) are commonly used in the management of rheumatoid arthritis. They have been studied extensively, with numerous clinical trials demonstrating their efficacy over placebo treatments. Both drugs work by targeting specific parts of the immune system to reduce inflammation that causes joint damage and pain. However, they do so through different mechanisms: Orencia works primarily by inhibiting T-cell activation, while Actemra acts to inhibit interleukin-6 receptors.
While both can be used as first-line treatment options after failure of conventional DMARDs like methotrexate, choice between these two is often determined by individual patient factors and physician's judgment.
Both drugs are biologics and thus don't have generic versions available yet which makes them more expensive compared to traditional DMARDs. The initiation of therapy with either drug may require an adjustment period until full therapeutic effects become evident.
The side effect profile for both medications is similar, though there are some differences due to their distinct modes of action. Both carry risks such as serious infections due to suppression of the immune system but this risk should be weighed against the benefit provided in reducing symptoms and slowing disease progression. As always patients need close monitoring especially when starting or changing dosages on these medications.
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Refrences
- Elmedany, S. H., Mohamed, A. E., & Galil, S. M. A. (2019, March 26). Efficacy and safety profile of intravenous tocilizumab versus intravenous abatacept in treating female Saudi Arabian patients with active moderate-to-severe rheumatoid arthritis. Clinical Rheumatology. Springer Science and Business Media LLC.http://doi.org/10.1007/s10067-019-04508-2
- Oldfield, V., Dhillon, S., & Plosker, G. L. (2009). Tocilizumab. Drugs. Springer Science and Business Media LLC.http://doi.org/10.2165/00003495-200969050-00007