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Otezla vs Enbrel
Introduction
For patients with psoriasis or psoriatic arthritis, certain drugs that alter the immune response in the body can help manage symptoms and slow disease progression. Otezla and Enbrel are two such drugs that are commonly prescribed for these conditions. Each of them operates on different pathways within the immune system, but both have demonstrated effectiveness in managing symptoms associated with these skin and joint disorders. Otezla specifically works by inhibiting an enzyme called phosphodiesterase 4 (PDE4), which ultimately leads to a reduction in inflammation-causing molecules within cells. On the other hand, Enbrel is classified as a tumor necrosis factor (TNF) blocker; it acts by blocking TNF, a protein produced by your immune system when inflammation occurs.
Otezla vs Enbrel Side By Side
| Attribute | Otezla | Enbrel |
|---|---|---|
| Brand Name | Otezla | Enbrel |
| Contraindications | Cannot be taken with other drugs that suppress the immune system, requires screening for tuberculosis before starting treatment | Cannot be taken with other drugs that suppress the immune system, requires screening for tuberculosis before starting treatment |
| Cost | Approximately $3700 for 60 tablets of 30 mg | Approximately $5000 for four injections of 50 mg |
| Generic Name | Apremilast | Etanercept |
| Most Serious Side Effect | Increased risk of depression or suicidal thoughts | Increased risk of serious infections, including tuberculosis and infections caused by viruses, fungi, or bacteria |
| Severe Drug Interactions | May have dangerous interactions with other immune-suppressing drugs | May have dangerous interactions with other immune-suppressing drugs |
| Typical Dose | 20-30 mg twice daily, with 30 mg twice daily being sufficient for most people | 50 mg per week via subcutaneous injection, or 25 mg injected twice weekly |
What is Otezla?
Apremilast (the generic name for Otezla) is an oral medication that was a significant advancement in the treatment of psoriasis and psoriatic arthritis, compared to the earlier biologic drugs like Etanercept (Enbrel). Apremilast was first approved by the FDA in 2014. It works differently from traditional treatments – instead of directly impacting the immune system, it inhibits an enzyme within your cells called PDE-4, which eventually leads to reduced inflammation. This drug is prescribed for moderate to severe plaque psoriasis and active forms of psoriatic arthritis. By targeting PDE-4, Otezla shows a more specific action with fewer side effects than Enbrel that modulates the immune system as a whole by blocking TNF-alpha.
What conditions is Otezla approved to treat?
Otezla and Enbrel are utilized for the management of several inflammatory conditions:
- Otezla is approved for psoriatic arthritis, plaque psoriasis, and oral ulcers associated with Behçet's disease.
- Enbrel is indicated primarily for rheumatoid arthritis, juvenile idiopathic arthritis (in patients aged 2 years or older), psoriatic arthritis, ankylosing spondylitis, and plaque psoriasis.
How does Otezla help with these illnesses?
Otezla assists in managing psoriasis and psoriatic arthritis by reducing inflammation in the body. It accomplishes this by inhibiting an enzyme called phosphodiesterase 4 (PDE4), which plays a role in regulating immune responses, including inflammation. By blocking PDE4, Otezla boosts levels of cyclic adenosine monophosphate (cAMP), a messenger molecule that helps reduce inflammation. In conditions like psoriasis and psoriatic arthritis, there is excessive immune response leading to heightened inflammation; hence, increasing cAMP can help control these symptoms and manage these conditions better.
On the other hand, Enbrel works by specifically targeting tumor necrosis factor-alpha (TNF-alpha), a protein involved in systemic inflammation processes. Thus it directly blocks one of the key signaling proteins involved in inflammatory reactions. This makes Enbrel particularly effective for autoimmune diseases where overactive immune response results in increased levels of TNF-alpha causing chronic pain and discomfort.
Both drugs are designed to decrease abnormal inflammatory responses but through different mechanisms of action giving patients options depending on their specific condition.
What is Enbrel?
Enbrel, the brand name for etanercept, is a type of protein known as a tumor necrosis factor (TNF) inhibitor. It works by reducing the action of TNF, which plays an instrumental role in promoting inflammation and its related symptoms in conditions like rheumatoid arthritis and psoriasis. Enbrel was first approved by the FDA in 1998.
Unlike Otezla, which is classified as a phosphodiesterase-4 (PDE4) inhibitor that modulates immune response but does not directly target TNF factors, Enbrel's focus on TNF provides it with specific advantages when dealing with these autoimmune disorders. This means that its side-effect profile will differ from PDE4 inhibitors such as Otezla - it tends to cause less gastrointestinal discomfort but may increase susceptibility to infections due to its immunosuppressive properties. The targeted effects on TNF can be particularly beneficial for treating inflammatory diseases especially in patients who do not respond well to other classes of drugs.
What conditions is Enbrel approved to treat?
Enbrel is a widely approved treatment for several autoimmune conditions, including:
- Rheumatoid arthritis
- Juvenile idiopathic arthritis
- Psoriatic arthritis
- Ankylosing spondylitis
- Plaque psoriasis in both adults and children who are at least 4 years old.
It works by blocking the activity of a substance your body's immune system makes called TNF. Too much TNF can cause the immune system to attack healthy body tissues and lead to inflammation. By blocking the action of TNF, Enbrel helps reduce this inflammation.
How does Enbrel help with these illnesses?
Tumor necrosis factor (TNF) is a cell signalling protein, also known as a cytokine, that plays pivotal roles in cellular activity such as inflammation and immune response. It has been implicated heavily in autoimmune conditions like psoriasis and rheumatoid arthritis. Enbrel works by acting as a TNF inhibitor - it binds to TNF molecules and blocks their interaction with the body's cells, thereby reducing inflammatory responses and alleviating some symptoms of these conditions. Its actions on other cytokines may also play roles in its effectiveness as an immunosuppressant drug. Since it does not significantly affect phosphodiesterase levels unlike Otezla, it is sometimes prescribed when a patient does not respond well to 'typical' PDE4 inhibitors or may be combined with them for more comprehensive treatment.
How effective are both Otezla and Enbrel?
Apremilast (Otezla) and etanercept (Enbrel) both are effective medications for managing psoriasis, but they work in different ways and were approved by the FDA several years apart. Otezla works by inhibiting an enzyme called phosphodiesterase 4 to reduce inflammation, while Enbrel is a TNF inhibitor that blocks the activity of tumor necrosis factor alpha, a substance in the body that leads to inflammation.
Several studies have compared these two drugs directly. A 2018 clinical study found similar efficacy between Otezla and Enbrel in reducing symptoms of moderate to severe plaque psoriasis over a period of 16 weeks. However, side effect profiles differed somewhat: diarrhea and nausea were more common with Otezla, while injection site reactions were more common with Enbrel.
A review from 2016 indicated that PDE4 inhibitors like apremilast may provide another option for patients who do not respond well or cannot tolerate traditional systemic therapies or biologics like TNF inhibitors due to their less-severe side effects profile. Additionally, as an oral medication, it also offers convenience over injectable treatments such as etanercept.
As per meta-analysis reports on etanercept from around same time frame show its effectiveness at treating rheumatoid arthritis along with other inflammatory conditions including juvenile idiopathic arthritis and psoriatic arthritis starting from early stages of treatment. Its safety profile is generally favorable when compared with other biological agents used for inflammatory diseases. As one of the first TNF-inhibitors developed there is a significant history supporting its use across various indications.
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At what dose is Otezla typically prescribed?
Oral dosages of Otezla range from 20-30 mg twice daily, but studies have indicated that 30 mg twice daily is sufficient for treating psoriatic arthritis in most people. Children and adolescents under the age of 18 should not use this drug due to lack of safety and efficacy data. The usual dose for Enbrel, on the other hand, ranges between 25-50 mg per week via subcutaneous injection depending on the severity of the disease being treated; children as young as two years old can be prescribed a specific dosage based on their weight. For either medication, if there isn't any response after several weeks, your healthcare provider may need to adjust your regimen or consider alternative treatments.
At what dose is Enbrel typically prescribed?
Enbrel treatment for moderate to severe rheumatoid arthritis typically begins with a dosage of 50 mg per week. The dose is administered as one single injection under the skin, usually around the same day each week. For some patients, based on their physician's guidance, a regimen of 25 mg can be injected twice weekly with an approximately three to four days gap between doses. It's worth noting that maximum dosage should not exceed 50 mg per week. If after several weeks there isn't sufficient response to treatment at this level, further consultation and evaluation with your healthcare provider would be necessary because Enbrel may not be the most effective choice for you.
What are the most common side effects for Otezla?
Common side effects of Otezla (apremilast) may include:
- Diarrhea, nausea, and vomiting
- Headache
- Upper respiratory tract infection symptoms such as sinusitis
- Tension or depression
- Insomnia
- Decreased appetite
- Back pain
On the other hand, common side effects of Enbrel (etanercept) can include:
- Injection site reactions (redness, itching, bleeding, swelling)
- Infections such as the flu or sinus infections
- Headaches and dizziness
- Rash
- Respiratory conditions like a cough or runny nose
Both medications have unique profiles that should be considered in relation to individual health status. Always consult your healthcare provider for guidance on medication choices.
Are there any potential serious side effects for Otezla?
While both Otezla and Enbrel are used to treat conditions like psoriasis, they may have different side effects. Here's what you need to know:
- The use of Otezla has been associated with an increased risk of depression or suicidal thoughts in some patients. If you experience any mood changes while on this medication, contact your healthcare provider immediately.
- Both medications can potentially cause severe allergic reactions characterized by hives, difficulty breathing, swelling in your face or throat, fever, sore throat and a red or purple skin rash that blisters and peels.
- Vision problems such as blurred vision, tunnel vision, eye pain or seeing halos around lights could occur while on either medication.
- You should also be aware of symptoms indicating heart issues such as fast or pounding heartbeats, fluttering in your chest shortness of breath and sudden dizziness; these require immediate medical attention.
- Although less common with these drugs than others mentioned earlier; low sodium levels (causing headache confusion slurred speech severe weakness vomiting loss of coordination feeling unsteady) should still be considered as potential adverse events
- Severe nervous system reaction is another rare but serious condition that might manifest itself through stiff muscles high fever sweating confusion fast uneven heartbeats tremors feeling like passing out It's important to remember everyone reacts differently to medications—what works well for one person may not work as well for another. Always consult with your physician before making any decisions about medication.
What are the most common side effects for Enbrel?
Enbrel, another medication used to treat severe cases of psoriasis and arthritis, is associated with its own set of potential side effects. These may include:
- Injection site reactions such as redness, swelling or pain
- Headaches and dizziness
- Respiratory infections including sinusitis or sore throat
- Nausea and stomach discomfort
- Mild rash on the skin
- Reduced appetite which might lead to weight loss in some individuals
- Increased risk of developing serious infections due to weakened immunity.
It's important for patients taking Enbrel to monitor their health closely and report any unusual symptoms or changes immediately. If you're considering this medication as part of your treatment plan, please consult with your doctor about these potential risks.
Are there any potential serious side effects for Enbrel?
While Enbrel is generally well-tolerated by most patients, it can in rare cases cause serious side effects. These may include:
- Signs of an allergic reaction such as hives, difficulty breathing, swelling of your face, lips, tongue or throat
- Infections that can be severe - including tuberculosis and infections caused by viruses, fungi or bacteria
- Hepatitis B infection in carriers of the virus
- Allergic reactions during or after injection with Enbrel. Some reactions could be serious
- Nervous system problems such as multiple sclerosis, seizures or inflammation of the nerves of the eyes
- Unusual bleeding (this might indicate a decrease in blood platelets)
- Swelling around the ankles
If you notice any abnormal symptoms while using Enbrel, consult your healthcare provider immediately.
Contraindications for Otezla and Enbrel?
Both Otezla and Enbrel, as with most other psoriasis medications, may worsen symptoms in some people. If you notice your skin condition exacerbating or the occurrence of new health issues such as respiratory problems, please seek immediate medical attention.
Neither Otezla nor Enbrel can be taken if you are taking other drugs that suppress the immune system. Always inform your physician about all medications you are currently using; it will take some time for these immune-suppressing drugs to clear from your body to prevent dangerous interactions with Otezla and Enbrel.
Moreover, both medicines require screening for tuberculosis before starting treatment because they can cause latent TB to become active. It's also important to note that while both act on the immune response, they do so differently - Enbrel blocks TNF-alpha (a protein involved in systemic inflammation), whereas Otezla inhibits an enzyme called PDE4. Therefore, their side effects may differ significantly based on individual physiology.
How much do Otezla and Enbrel cost?
For the brand name versions of these drugs:
- The price of 60 tablets of Otezla (30 mg) averages around $3700, which works out to approximately $123/day, when taken twice daily as typically prescribed.
- The price for four injections of Enbrel (50 mg), sufficient for one month's supply, averages around $5000, working out to about $166/day.
Thus if you are taking standard dosages of each drug, brand-name Enbrel is more expensive on a per-day treatment basis. Please remember that cost should not be the primary consideration in determining which of these drugs is right for you; effectiveness and side effects play crucial roles too.
Currently no generic versions exist for either Otezla or Enbrel due to patent restrictions. It’s important to note that prices can vary depending upon your location and insurance coverage.
Always consult with your healthcare provider and pharmacist to understand the potential costs associated with any medication regimen.
Popularity of Otezla and Enbrel
Apremilast, available under the brand name Otezla, was estimated to have been prescribed to about 200,000 people in the US in 2020. Apremilast accounted for around 8% of prescriptions for psoriasis and psoriatic arthritis treatments. This small-molecule inhibitor of phosphodiesterase-4 (PDE4) has seen a steady increase in its usage since it was approved by FDA in 2014.
Etanercept, marketed as Enbrel among other brands, has been a mainstay treatment option for moderate-to-severe rheumatoid arthritis and certain types of psoriasis since its introduction over two decades ago. According to IMS Health data, approximately nearly one million Americans were treated with etanercept products during 2020 alone – this accounts for just under half of all biologic disease-modifying antirheumatic drug (DMARD) prescriptions. Despite newer therapies entering the market, Enbrel's prevalence has remained relatively stable over the past decade due to its proven efficacy and safety profile.
Conclusion
Both Otezla (apremilast) and Enbrel (etanercept) are widely used by patients with chronic inflammatory conditions such as psoriasis and rheumatoid arthritis. Both of these medications have been backed by numerous clinical studies, indicating that they're more effective than placebo treatments. While both drugs can be prescribed individually, their concurrent use requires careful consideration from the attending physician due to potential contraindications.
Otezla works by inhibiting an enzyme called phosphodiesterase 4 (PDE4), reducing inflammation in the body, while Enbrel is a tumor necrosis factor inhibitor that also reduces inflammation but through a different mechanism. Hence, they may be prescribed under different circumstances depending on patient profile and response to treatment.
While there's no generic version for either medication yet which could represent significant cost savings for out-of-pocket payers, patient assistance programs are offered by manufacturers of both drugs to help with costs.
Both Otezla and Enbrel might require some adjustment period where effects may not be immediate or noticeable right away.
In terms of side-effects profiles, both drugs are generally well-tolerated although each drug comes with its unique set of possible side effects. For instance, Otezla users might experience diarrhea or nausea whereas Enbrel users must take precautions against infections due to immune system suppression caused by the drug. Regardless of which medication one is using it is vital to closely monitor any changes in health status especially when initiating therapy.
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Refrences
- Chimenti, M. S., Gramiccia, T., Saraceno, R., Bianchi, L., Garofalo, V., Buonomo, O., … Chiricozzi, A. (2015, August 4). Apremilast for the treatment of psoriasis. Expert Opinion on Pharmacotherapy. Informa Healthcare.http://doi.org/10.1517/14656566.2015.1076794
- 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
- Deeks, E. D. (2015, July 29). Apremilast: A Review in Psoriasis and Psoriatic Arthritis. Drugs. Springer Science and Business Media LLC.http://doi.org/10.1007/s40265-015-0439-1