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Rebif vs Tecfidera
Introduction
For patients dealing with multiple sclerosis (MS), a degenerative condition that affects the central nervous system, certain medications can help manage symptoms and slow disease progression. Rebif and Tecfidera are two such drugs often prescribed for MS treatment. They each have different ways of interacting with the body but both aim to reduce relapses and slow down physical disability in patients with MS.
Rebif is an interferon beta-1a medication that works by regulating immune system activities to decrease inflammation, thus reducing nerve damage caused by MS. It's usually administered through subcutaneous injections three times per week.
On the other hand, Tecfidera is classified as a dimethyl fumarate drug, which functions by activating a pathway in cells connected to reducing inflammation and protecting against cell destruction; it is taken orally twice daily. The choice between these two treatments depends largely on the patient’s lifestyle, medical history, tolerance for side effects among others.
Rebif vs Tecfidera Side By Side
| Attribute | Rebif | Tecfidera |
|---|---|---|
| Brand Name | Rebif | Tecfidera |
| Contraindications | Should not be taken if on certain biologics due to risk of potential drug interaction. Liver function tests need to be monitored. | White blood cell count needs to be monitored due to effect on the immune system. |
| Cost | $7,000 for a monthly supply | $6,800 per month |
| Generic Name | Interferon beta-1a | Dimethyl fumarate |
| Most Serious Side Effect | Serious allergic reactions, heart problems, severe kidney issues, liver problems | PML (progressive multifocal leukoencephalopathy), severe skin reactions |
| Severe Drug Interactions | Not specified, but interactions with biologics mentioned | Not specified |
| Typical Dose | 22–44 mcg three times per week | 120mg twice daily for the first week, then 240mg twice daily |
What is Rebif?
Interferon beta-1a (the generic name for Rebif) was one of the first disease-modifying therapies (DMTs) approved by the FDA in 2002 for treating relapsing forms of multiple sclerosis. Rebif works by modulating the body's immune response to reduce inflammation and slow down the progression of physical disability associated with MS. It comes in an injectable form that patients self-administer subcutaneously three times a week.
On the other hand, Dimethyl fumarate (the generic name for Tecfidera), is an oral medication approved by FDA in 2013 as another treatment option for relapsing forms of MS. Unlike Rebif, which modifies the immune system’s response to inflammation, Tecfidera works inside cells to protect them from damage and reduce inflammation.
While both drugs are effective at managing symptoms and slowing disease progression, their route of administration and side effect profile differ significantly. Patients on Rebif may experience flu-like symptoms after injections while those taking Tecfidera may report gastrointestinal problems such as stomach pain or diarrhea. Ultimately, choosing between these two medications will depend upon individual patient preference, tolerance to potential side effects, lifestyle considerations like convenience or fear of needles and discussion with healthcare providers.
What conditions is Rebif approved to treat?
Rebif and Tecfidera are both approved treatments for certain forms of multiple sclerosis:
- Rebif is approved for the treatment of relapsing forms of multiple sclerosis (MS), including clinically isolated syndrome, relapsing-remitting disease, and active secondary progressive disease.
- Tecfidera is approved for the management and treatment of patients with relapsing forms of MS.
How does Rebif help with these illnesses?
Rebif helps to manage multiple sclerosis (MS) by mimicking a protein called interferon beta that naturally occurs in the body, which is known to reduce inflammation and slow damage to nerve cells. It does this by binding to receptors on cell surfaces, signaling them to behave as if they were interacting with natural interferon beta. This includes reducing inflammatory responses and slowing down the rate at which nerve cells are damaged. Multiple sclerosis can cause a variety of symptoms varying from fatigue and difficulty walking to more serious issues like paralysis or loss of vision due its nature of damaging the protective covering of nerve fibers in your brain and spinal cord. Therefore, by imitating interferon beta, Rebif can limit the negative effects of MS and help patients manage their condition.
On the other hand, Tecfidera works differently but also targets multiple sclerosis management. It's believed that it inhibits an enzyme (called pyruvate dehydrogenase kinase) involved in cellular energy production processes within immune cells – an action thought to have anti-inflammatory effects which protect against further damage in MS.
What is Tecfidera?
Tecfidera, which is the brand name for dimethyl fumarate, is an oral medication that has been approved by the FDA in 2013 for relapsing forms of multiple sclerosis. This drug works differently than Rebif as it activates a pathway inside cells (the Nrf2 pathway) that helps protect them from damage and inflammation. Tecfidera offers patients with relapsing MS a different treatment mechanism to manage their disease since it does not involve any injections like interferon beta-1a drugs such as Rebif. Instead of interfering directly with the immune system's activity like Rebif, Tecfidera targets specific cellular processes to reduce inflammation and promote nerve cell health in patients with Multiple sclerosis. The side effect profile of Tecfidera also differs from those of interferons; flushing and gastrointestinal issues are common side effects but they generally decrease over time or can be managed through dose adjustments or symptomatic treatments.
What conditions is Tecfidera approved to treat?
Tecfidera is an oral medication approved for the treatment of relapsing forms of multiple sclerosis (MS), including clinically isolated syndrome, relapsing-remitting disease, and active secondary progressive disease. This makes it a versatile option in managing various stages and forms of MS.
How does Tecfidera help with these illnesses?
Dimethyl fumarate, the active ingredient in Tecfidera, has a different mechanism of action than interferon beta-1a found in Rebif. It works by modifying the immune response and reducing inflammation within the central nervous system. This effectively reduces flare-ups and slows down the progression of physical disability associated with multiple sclerosis (MS). Tecfidera not only lessens relapses but also decreases the formation of new lesions as detected on MRI scans. Although it doesn't directly affect levels of cytokines or immunoglobulins like some other MS treatments do (such as Rebif), its unique method of action can be beneficial for patients who don't respond well to those more "typical" MS drugs or have issues with their side effects. It may be prescribed alone or combined with other MS medications for comprehensive management.
How effective are both Rebif and Tecfidera?
Interferon beta-1a (Rebif) and dimethyl fumarate (Tecfidera) are both approved by the FDA for the treatment of relapsing forms of multiple sclerosis. They work through different mechanisms: Rebif is a type of protein that modulates inflammatory responses, while Tecfidera protects against oxidative stress which can damage nerve cells.
The efficacy of each drug in mitigating symptoms and slowing disease progression was directly studied in separate clinical trials. For instance, the PRISMS trial(1998) demonstrated that Rebif reduced relapse rates significantly compared to placebo over two years. On the other hand, CONFIRM(2012), a phase 3 trial evaluated Tecfidera against glatiramer acetate(another MS medication) and placebo; it showed that Tecfidera reduced annualized relapse rates significantly more than placebo but there was no statistically significant difference between Tecfidera and glatiramer acetate.
A comprehensive review in 2009 highlighted Interferon beta-1a's effectiveness at reducing flare-ups from the early stages of treatment onward and its favorable side effect profile when compared with other injectable treatments for MS. It also noted its wide use worldwide due to its long history as one of the first therapies developed specifically for MS.
Contrarily, a 2016 Cochrane review found dimethyl fumarate to be more effective than placebo at preventing relapses over two years but found insufficient evidence on whether it prevents disability progression because longer-term data were not available then. While interferons such as Rebif are often used as first-line therapy given their extensive track record, some patients experience flu-like symptoms after injections or develop neutralizing antibodies making treatment less effective over time. Dimethyl fumarate may be considered instead particularly if oral administration is preferred though flushing and gastrointestinal problems like nausea are common initially before subsiding somewhat with continued use.
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At what dose is Rebif typically prescribed?
Subcutaneous dosages of Rebif range from 22–44 mcg three times per week, but studies have indicated that 22 mcg three times weekly is sufficient for treating relapsing forms of multiple sclerosis in most people. Dosage may be increased to 44 mcg three times weekly after a month if there is no response. The maximum dosage that should not be exceeded in any case is 44 mcg three times per week.
On the other hand, oral dosages of Tecfidera involve starting with a lower dose (120 mg twice daily) for seven days and then increasing to the maintenance dose (240 mg twice daily). This step-up approach helps improve gastrointestinal tolerance to the drug. Patients are advised not to crush, chew or sprinkle capsules contents on food—the capsule must be swallowed whole.
At what dose is Tecfidera typically prescribed?
Tecfidera treatment for multiple sclerosis is typically initiated at a dosage of 120mg twice daily. After the first week, the dose can be escalated to its maintenance level of 240mg taken orally twice daily, making sure doses are approximately 12 hours apart. If patients struggle with gastrointestinal side effects, they may maintain the starting dose longer before increasing to full strength. The maximum dose should not exceed 480 mg/day divided into two doses. It's crucial that if there's no notable response or improvement in symptoms after several weeks on this regimen, you discuss further options with your healthcare provider.
What are the most common side effects for Rebif?
Possible side effects of Rebif may include:
- Flu-like symptoms including fever, chills, muscle aches and tiredness
- Depression or suicidal thoughts
- Liver problems, with symptoms such as yellowing of the skin or eyes, dark urine, easy bruising or bleeding
- Changes in thyroid function which might cause changes in mood or energy levels
- Allergic reactions characterized by hives; difficulty breathing; swelling of your face, lips, tongue or throat.
On the other hand Tecfidera's possible side effects can include:
- Flushing (warmth, redness under your skin)
- Stomach pain and indigestion
- Nausea and vomiting
- Diarrhea
- Decreased white blood cell count which could increase the risk for infection. A serious brain infection called progressive multifocal leukoencephalopathy (PML) has been reported with its use.
Are there any potential serious side effects for Rebif?
In rare cases, Rebif and Tecfidera can cause potentially severe side effects:
- Serious allergic reactions: symptoms include hives or skin rash, difficulty breathing or swallowing, swelling of the face or throat
- Heart problems: rapid heart rate, chest pain, feeling faint or shortness of breath
- Severe kidney issues: lower back pain, blood in your urine, little to no urination
- Liver problems: nausea, upper stomach pain and discomfort that may progress to an intense level; jaundice (yellowing) of the skin or eyes; dark-colored urine.
Tecfidera specifically can also lead to PML (progressive multifocal leukoencephalopathy), a very rare brain infection that can result in death. Symptoms include progressive weakness on one side of body; clumsiness; vision changes and loss of coordination.
Rebif users should watch for flu-like symptoms including fever and muscle aches. If any such signs appear after taking either medication contact your healthcare provider immediately.
What are the most common side effects for Tecfidera?
While Rebif has its own potential side effects, it's crucial to understand the ones associated with Tecfidera as well. These include:
- Nausea, vomiting, stomach pain or upset
- Diarrhea and weight loss due to gastrointestinal issues
- Flushing which may cause redness, itching or a rash
- Headache or dizziness
- Changes in blood cell count that could lead to an increased risk of infection There may also be more serious rare side effects such as progressive multifocal leukoencephalopathy (PML - a rare brain infection). It is important to discuss these potential risks with your healthcare provider before starting treatment.
Are there any potential serious side effects for Tecfidera?
While Tecfidera is generally considered to be safe, it can cause serious side effects in some cases. These might include:
- Signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat
- Signs of a severe skin reaction: fever, sore throat, burning eyes, skin pain; red or purple skin rash with blistering and peeling
- Decreased white blood cell counts leading to increased infections
- Kidney problems - little or no urination; painful or difficult urination; swelling in your feet or ankles; feeling tired
- Liver problems - loss of appetite, upper stomach pain (that may spread to your back), tiredness, dark urine coloration
- Flushing reactions such as warmth sensation/redness/itchiness/burning feeling especially if taken without food.
If you experience any of these symptoms while on Tecfidera treatment regime stop taking the medication immediately and consult your doctor for further advice.
Contraindications for Rebif and Tecfidera?
Both Rebif and Tecfidera, along with most other medications used to treat multiple sclerosis (MS), may exacerbate symptoms in some individuals. If you notice your MS symptoms worsening or experience any new or unusual symptoms, please seek immediate medical attention.
Neither Rebif nor Tecfidera should be taken if you are currently on certain types of medications known as biologics due to the risk of potential drug interaction. Always inform your healthcare provider about all the medications you are taking; these could require a period of time to clear from your system before starting treatment with either Rebif or Tecfidera.
Rebif is a type of interferon therapy that is administered through injections under the skin three times per week. It can cause flu-like side effects which usually improve over time. Liver function tests need to be monitored while on this medication.
Tecfidera, an oral medication taken twice daily, can cause flushing and stomach problems like diarrhea, nausea, and abdominal pain. These side effects usually decrease over time but it's important for patients taking this medication to have their white blood cell count monitored due its effect on the immune system.
How much do Rebif and Tecfidera cost?
For the brand name versions of these drugs:
- The price of Rebif (22 mcg) averages around $7,000 for a monthly supply which works out to approximately $230/day.
- The price of Tecfidera (240 mg) on average is about $6,800 per month, working out to roughly $226/day.
Thus, if you are in the higher dosage range for Rebif (i.e., 44 mcg three times a week), then brand-name Tecfidera may be less expensive on a per-day treatment basis. Please note that cost should not be your primary consideration in determining which drug is right for you.
Currently there are no generic versions available for either Rebif or Tecfidera. These medications can often be covered partly or fully by insurance plans and patient assistance programs offered by their respective manufacturers also exist to help offset costs.
Popularity of Rebif and Tecfidera
Rebif and Tecfidera are both commonly prescribed drugs for treating relapsing forms of multiple sclerosis (MS).
In 2020, Rebif was estimated to be used by about 18% of the MS patient population in the US. It is an injectable medication that works by mimicking a naturally occurring protein in your body (interferon beta-1a) which helps control your immune system and reduce inflammation.
On the other hand, Tecfidera has seen increasing popularity since its approval in 2013. By 2020, it was prescribed to nearly one third of all MS patients. Unlike Rebif, Tecfidera is an oral drug that decreases inflammatory responses within the central nervous system and protects nerve cells against damage.
While both medications have proven effective at reducing relapses and slowing disease progression, their side effect profiles vary significantly with more injection site reactions reported for Rebif while flushing and gastrointestinal issues were more common with Tecfidera.
Conclusion
Both Rebif (interferon beta-1a) and Tecfidera (dimethyl fumarate) have proven track records in managing multiple sclerosis, with numerous clinical studies supporting their efficacy over placebo treatments. The drugs are rarely combined, since this would require careful consideration by a healthcare provider due to possible increased risk of side effects. Both medications work differently; Rebif boosts the body's innate anti-inflammatory processes while Tecfidera shields the nervous system cells from damage.
Rebif is often chosen as a first-line treatment option for relapsing forms of MS, whereas Tecfidera may be considered an alternative for those who cannot tolerate or do not respond well to interferons such as Rebif. However, both drugs can be used initially depending on individual factors.
While no generic versions exist yet for either drug, various assistance programs can help offset costs especially for patients paying out-of-pocket. Starting these medications might involve an adjustment period where full benefits may not be immediately noticed.
Each medication has its unique side effect profile; however generally both are well-tolerated with appropriate monitoring and dose adjustments if needed. With Rebif there could be flu-like symptoms post injection while Tecfidera might cause flushing or gastrointestinal discomforts among others. Patients using either drug should report any new or worsening symptoms promptly to their healthcare providers.
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Refrences
- Sheremata, W., Brown, A. D., & Rammohan, K. W. (2014, November 8). Dimethyl fumarate for treating relapsing multiple sclerosis. Expert Opinion on Drug Safety. Informa UK Limited.http://doi.org/10.1517/14740338.2015.977251
- Sattarnezhad, N., Healy, B. C., Baharnoori, M., Diaz-Cruz, C., Stankiewicz, J., Weiner, H. L., & Chitnis, T. (2022, July 11). Comparison of dimethyl fumarate and interferon outcomes in an MS cohort. BMC Neurology. Springer Science and Business Media LLC.http://doi.org/10.1186/s12883-022-02761-8