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Tremfya vs Stelara
Introduction
For patients suffering from moderate to severe plaque psoriasis, certain medications can help control the overactive immune response that leads to the formation of skin cells. Tremfya and Stelara are two such drugs prescribed for this condition. They both target different proteins involved in inflammation but have similar effects in reducing symptoms of psoriasis.
Tremfya is a monoclonal antibody that binds specifically to interleukin-23 (IL-23), a cytokine protein that plays a key role in managing the immune system and inflammatory disorders. By inhibiting IL-23, Tremfya helps control the excessive cell growth associated with plaque psoriasis.
On the other hand, Stelara works slightly differently by targeting and blocking two specific cytokines: interleukin-12 (IL-12) and interleukin-23 (IL-23). This dual-action approach allows it not only to manage symptoms of plaque psoriasis but also has been shown effective against Crohn's disease and ulcerative colitis.
Tremfya vs Stelara Side By Side
| Attribute | Tremfya | Stelara |
|---|---|---|
| Brand Name | Tremfya | Stelara |
| Contraindications | Active tuberculosis (TB) or any other severe infections, currently taking immunosuppressive drugs | Active tuberculosis (TB) or any other severe infections, currently taking immunosuppressive drugs |
| Cost | Approximately $125/day | Approximately $142/day |
| Generic Name | Guselkumab | Ustekinumab |
| Most Serious Side Effect | Signs of serious infection such as fever, sweats or chills; muscle aches; cough that won't stop or brings up mucus; shortness of breath; blood in phlegm; loss of weight without trying, skin reactions including rash, itching or hives, swelling of the face, lips or tongue which may lead to difficulty swallowing or breathing. | Serious infections: tuberculosis (TB), bacterial sepsis, invasive fungal infections (such as histoplasmosis), and infections due to other opportunistic pathogens, allergic reactions: rash, hives and swelling of the face, increased risk for skin cancer, reversible posterior leukoencephalopathy syndrome (RPLS): symptoms like headache, seizures confusion and visual problems |
| Severe Drug Interactions | Immunosuppressive drugs | Immunosuppressive drugs |
| Typical Dose | 100mg injected subcutaneously at the start, followed by another dose four weeks later and then every eight weeks thereafter | For plaque psoriasis, 45 mg or 90 mg depending on the patient's weight, administered subcutaneously at weeks 0 and 4, then every twelve weeks |
What is Tremfya?
Guselkumab (the generic name for Tremfya) and Ustekinumab (Stelara) are both monoclonal antibodies that inhibit specific proteins in the immune system to help control inflammatory conditions. They represent a significant advancement from older, non-specific immunosuppressive medications. Guselkumab was approved by the FDA in 2017 specifically for the treatment of moderate to severe plaque psoriasis. It works by binding to a protein called interleukin-23 (IL-23), blocking its activity, thereby reducing inflammation and other symptoms of psoriasis. In contrast, Stelara binds to and inhibits both IL-12 and IL-23 which can treat not only psoriasis but also Crohn’s disease and ulcerative colitis due to its broader mechanism of action. Both have proven efficacy though may differ slightly in their side effect profiles due to their different modes of action.
What conditions is Tremfya approved to treat?
Tremfya and Stelara are both approved for the treatment of specific conditions:
- Tremfya is used for moderate to severe plaque psoriasis who may benefit from taking injections or pills (systemic therapy) or phototherapy (treatment using ultraviolet light alone or with pills).
- Stelara, on the other hand, is used to treat moderate-to-severe plaque psoriasis in adults and children aged 12 years and older. It's also effective in treating active psoriatic arthritis in adults, alone or with methotrexate; moderately-to-severely active Crohn’s disease in adults; as well as moderately-to-severely active ulcerative colitis.
How does Tremfya help with these illnesses?
Tremfya helps to manage psoriasis by blocking the action of interleukin-23 (IL-23), a protein that contributes to inflammation in the body. It does this by binding to IL-23 and preventing it from interacting with its receptor on immune cells, thus suppressing the immune response that leads to symptoms of psoriasis. Interleukins are a group of cytokines, or small proteins, that act as messengers in the immune system and play an important role in cell-to-cell communication, immunity and inflammation responses. It is thought that individuals with psoriasis have overactive IL-23 signaling pathways. Therefore, by inhibiting IL-23, Tremfya can limit the negative effects of psoriasis and help patients manage their condition effectively.
What is Stelara?
Stelara, known generically as ustekinumab, is a medication that works by reducing the effects of interleukins (IL-12 and IL-23), which are proteins in the body that can cause inflammation and other immune responses. Approved by the FDA in 2009, Stelara primarily targets these specific proteins to reduce their impact on conditions such as psoriasis and Crohn's Disease.
Unlike Tremfya (guselkumab) which only binds to IL-23, Stelara's dual-action on both IL-12 and IL-23 provides it with a unique mode of action among medications used for these conditions. It is administered via injection under the skin or into a vein depending upon the condition being treated.
Side effects may be different from those associated with Tremfya due to its distinct mechanism of action; these include potential risks for infections due to suppressed immune response. However, for many patients who do not respond well or have adverse reactions to other treatments like Tremfya, Stelara might provide an alternative option. As always though, individual patient factors must be considered when choosing between these therapies.
What conditions is Stelara approved to treat?
Stelara is an FDA-approved medication, indicated for the management of several conditions:
- Moderate to severe plaque psoriasis in adults and children aged 12 years and older who are candidates for systemic therapy or phototherapy
- Active psoriatic arthritis in adults, alone or in combination with methotrexate
- Moderately to severely active Crohn's disease in adults who have failed or were intolerant to treatment with immunomodulators or corticosteroids.
How does Stelara help with these illnesses?
Interleukin 12 and 23 are cytokines that play a key role in the immune response of our body, contributing to the inflammation and skin cell overproduction seen in psoriasis. Stelara is a monoclonal antibody medication designed specifically to target and block these interleukins from binding to their receptors on the surface of cells, thereby reducing inflammation and slowing down rapid skin cell growth. Its mechanism makes it an effective treatment for moderate-to-severe plaque psoriasis as well as certain types of arthritis. In comparison with Tremfya, which solely targets Interleukin-23, Stelara's broader action can offer advantages for some patients depending upon their unique condition or response to medications. However, due consideration should be given to each patient's medical history and potential side effects before deciding on any course of treatment.
How effective are both Tremfya and Stelara?
Both guselkumab (Tremfya) and ustekinumab (Stelara) are effective medications for the treatment of moderate to severe plaque psoriasis, approved by the FDA in 2017 and 2009 respectively. Both act on specific interleukins that play key roles in inflammation, but they target different ones; Tremfya targets IL-23 exclusively while Stelara targets both IL-12 and IL-23.
The effectiveness of Tremfya and Stelara was directly compared in a double-blind clinical trial published in 2019; the two drugs showed similar efficacy profiles with respect to reducing symptoms of psoriasis as well as comparable safety profiles. In this study, none of the different metrics studied to measure efficacy differed significantly between patients receiving Tremfya or those receiving Stelara.
A review from 2020 concluded that Tremfya has shown great promise since its introduction to dermatology practice. It is generally well-tolerated with a low incidence rate of adverse events, making it an attractive option for many patients suffering from chronic plaque psoriasis.
On the other hand, according to another review conducted in 2016, Stelara also demonstrated solid performance against placebo groups when treating moderate-to-severe psoriasis over several weeks. Nonetheless, due its broader impact on immune response by targeting both IL-12 and -23 instead just one cytokine like Guselkumab does may lead clinicians towards prescribing Tremfya first if clinically appropriate. However significant research into co-prescription strategies involving these two therapies is still lacking.
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At what dose is Tremfya typically prescribed?
Dosages of Tremfya are typically 100mg injected subcutaneously at the start, followed by another dose four weeks later and then every eight weeks thereafter. Stelara dosages, on the other hand, vary depending on whether it's being used for psoriasis or Crohn's disease. For psoriasis, adults usually receive a single injection to start with, followed by another dose four weeks later and then every twelve weeks after this initial period. For Crohn’s disease treatment in adults, Stelara starts with one intravenous infusion followed by subcutaneous injections every eight weeks. The dosage can be adjusted according to individual response but exceeding the recommended maximum dosage is not advised under any circumstance.
At what dose is Stelara typically prescribed?
Stelara treatment for plaque psoriasis typically begins with a dose of 45 mg or 90 mg, depending on the patient's weight, administered subcutaneously at weeks 0 and 4. After this initial dosage, further doses are given every twelve weeks. For those with psoriatic arthritis, Stelara starts with a dose of 45 mg or 90 mg at weeks 0 and then again at week four. Following this initial phase, patients receive doses every twelve weeks. If there is no significant improvement in symptoms after several rounds of treatment, your healthcare provider might reassess your treatment plan.
What are the most common side effects for Tremfya?
Common side effects of Tremfya include:
- Upper respiratory infections
- Fatigue (general weakness and tiredness)
- Headache
- Diarrhea
- Arthralgia (joint pain)
- Gastroenteritis (inflammation in the stomach or intestines)
- Tinea infections (common fungal infection affecting skin, nails or hair)
On the other hand, Stelara may cause these common side effects:
- Nasopharyngitis (cold symptoms such as a sore throat or runny nose)
- Headache
- Fatigue
- Diarrhea Upper respiratory tract infection Vomiting
Each individual may respond differently to medication; thus it's essential to consult with your healthcare provider if you experience any adverse reactions.
Are there any potential serious side effects for Tremfya?
While both Tremfya and Stelara are used to treat psoriasis, they can have different side effects. In rare cases, Tremfya may cause:
- Signs of serious infection such as fever, sweats or chills; muscle aches; cough that won't stop or brings up mucus; shortness of breath; blood in phlegm; loss of weight without trying
- Skin reactions including rash, itching or hives
- Swelling of the face, lips or tongue which may lead to difficulty swallowing or breathing.
On the other hand, Stelara might trigger:
- Serious infections: tuberculosis (TB), bacterial sepsis, invasive fungal infections (such as histoplasmosis), and infections due to other opportunistic pathogens
- Allergic reactions: Rash, hives and swelling of the face -Increased risk for skin cancer -Reversible Posterior Leukoencephalopathy Syndrome (RPLS): Symptoms like headache, seizures confusion and visual problems
If you experience any severe symptoms while taking either drug you should seek medical attention immediately.
What are the most common side effects for Stelara?
Stelara, a widely used medication for people with moderate to severe plaque psoriasis, can present some side effects that patients should be aware of:
- Respiratory problems: Patients may experience symptoms such as stuffy nose and sore throat.
- Digestive issues: Nausea, vomiting or stomach pain can occur. Loss of appetite and constipation are also possible.
- Neurological symptoms: Headaches and dizziness might manifest in some cases.
- Skin reaction: Rash is a potential adverse effect associated with Stelara use.
- Sleep disturbances: Some users report experiencing insomnia when on this medication.
- Cardiovascular signs: Faster heartbeat has been noted but it’s not common.
While the above are known effects of Stelara, it's important to remember that every individual reacts differently to medications. Always speak with your healthcare professional if you are concerned about any side effects while taking Stelara.
Are there any potential serious side effects for Stelara?
Although Stelara is generally well-tolerated, it can lead to some adverse effects in certain cases. If you notice any of the following severe symptoms, seek immediate medical attention:
- Signs of an allergic reaction such as difficulty breathing; swelling of your face, lips, tongue or throat
- A skin rash that could be indicative of a severe reaction - redness, itching and blistering can occur
- Changes in mood or behavior that are not typical for you
- Vision problems including blurred vision or seeing halos around lights
- Rapid heart rate or irregular heartbeat patterns These side-effects are rare but serious. Should you experience these while on Stelara treatment, prompt consultation with your healthcare provider is highly recommended.
Contraindications for Tremfya and Stelara?
Both Tremfya and Stelara, like many other biologic medications utilized for the management of psoriasis, may worsen symptoms in some individuals. If you notice an increase in your psoriasis symptoms or a new appearance of other skin conditions while on these medications, please seek immediate medical attention.
Neither Tremfya nor Stelara should be taken if you have active tuberculosis (TB) or any other severe infections, or are currently taking immunosuppressive drugs that might interact with them. Always inform your physician about all the medications you are taking; immune system suppressants will require careful monitoring to avoid potential interactions with either Tremfya or Stelara. These drugs could also exacerbate pre-existing conditions such as congestive heart failure and neurological disorders so it's important to discuss your complete medical history with your doctor before starting treatment.
How much do Tremfya and Stelara cost?
For the brand name versions of these drugs:
- The price for a single dose (1 mL pre-filled syringe) of Tremfya (guselkumab) averages around $10,000. Since this medication is typically administered once every 8 weeks after initial doses at week 0 and week 4, it works out to approximately $125/day.
- The price for a single injection dose (45 mg/0.5 mL pre-filled syringe) of Stelara (ustekinumab) is about $12,000. It's usually administered once every 12 weeks after two starter doses at week 0 and week 4, which averages to roughly $142/day.
Thus, if you are comparing on a per-day treatment basis than brand-name Tremfya appears less expensive than Stelara. However, cost should not be a primary consideration in determining which of these drugs is right for you.
At present there are no generic versions available for either drug as they're both biologics - complex proteins produced using living cells - making them significantly more expensive to develop and produce compared with traditional small-molecule medications like Prozac or Wellbutrin.
Popularity of Tremfya and Stelara
Guselkumab, offered under the brand name Tremfya, is a biologic medication used to treat moderate to severe plaque psoriasis. It was introduced in 2017 and its use has been steadily increasing since then. In 2020, it had an estimated prescription base of around half a million people in the US.
Ustekinumab, sold under the brand name Stelara, is another biologic drug designed for treating moderate to severe plaque psoriasis as well as psoriatic arthritis and Crohn's disease. Also being somewhat new on the medical scene (FDA approved in 2009), like Tremfya its usage has also been slowly but surely growing. However due to having more treatment indications than Tremfya and being available for longer period of time, it was prescribed approximately twice as often compared with Guselkumab - reaching roughly one million patients across America in 2020.
Conclusion
Both Tremfya (guselkumab) and Stelara (ustekinumab) have proven efficacy in the management of psoriasis, supported by robust clinical trials demonstrating their superiority over placebo treatments. There may be instances where these drugs are used in combination with other treatments, but this would require careful evaluation by a physician due to potential contraindications. They work via different mechanisms: Tremfya specifically targets interleukin-23 (IL-23), while Stelara inhibits both IL-12 and IL-23.
Stelara has been on the market longer than Tremfya and is often considered a first-line biologic treatment for moderate-to-severe plaque psoriasis, whereas Tremfya might be prescribed when patients do not respond adequately to initial therapies or if they have specific needs that make it a more suitable choice.
Neither drug is available in generic form yet, which can impact cost considerations for out-of-pocket payers. Patients starting either drug should anticipate an adjustment period during which improvements may not be immediately noticeable.
As far as side effects go, both medications are generally well-tolerated but carry risks associated with immune system suppression such as infections. For both drugs, patients must closely monitor their health status especially when initiating treatment and seek immediate medical help if they experience severe symptoms like infection or allergic reactions.
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Refrences
- Kivelevitch, D. N., & Menter, A. (2015, April). Use of Brodalumab for the Treatment of Psoriasis and Psoriatic Arthritis. Immunotherapy. Informa UK Limited.http://doi.org/10.2217/imt.14.113
- Markham, A. (2017, August 17). Guselkumab: First Global Approval. Drugs. Springer Science and Business Media LLC.http://doi.org/10.1007/s40265-017-0800-7
- Lamb, Y. N., & Duggan, S. T. (2017, May 20). Ustekinumab: A Review in Moderate to Severe Crohn’s Disease. Drugs. Springer Science and Business Media LLC.http://doi.org/10.1007/s40265-017-0765-6
- McKeage, K. (2014, June). Ustekinumab: A Review of Its Use in Psoriatic Arthritis. Drugs. Springer Science and Business Media LLC.http://doi.org/10.1007/s40265-014-0242-4
- Croxtall, J. D. (2012, April). Spotlight on Ustekinumab in Moderate To Severe Plaque Psoriasis†. American Journal of Clinical Dermatology. Springer Science and Business Media LLC.http://doi.org/10.2165/11208650-000000000-00000
- Diels, J., Thilakarathne, P., Cameron, C., McElligott, S., Schubert, A., & Puig, L. (2020, January 29). Adjusted treatment COMPArisons between guSelkumab and uStekinumab for treatment of moderate‐to‐severe plaque psoriasis: the COMPASS analysis. British Journal of Dermatology. Oxford University Press (OUP).http://doi.org/10.1111/bjd.18634