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Xeljanz vs Humira
Introduction
For patients dealing with autoimmune diseases such as rheumatoid arthritis, psoriatic arthritis or ulcerative colitis, certain drugs that can modulate the immune system response are vital in managing symptoms and preventing further damage to the body. Xeljanz and Humira are two such drugs prescribed for these conditions. They each have different mechanisms of action but both aim to reduce inflammation and slow down disease progression.
Xeljanz is a Janus kinase (JAK) inhibitor which works by blocking specific enzymes within the immune cells, leading to decreased inflammation. On the other hand, Humira falls under a class of drug known as tumor necrosis factor-alpha (TNFα) inhibitors which work by neutralizing an inflammatory protein called TNFα in your body. This difference in mechanism means they may be suited to different individuals depending on their specific condition and overall health status.
What is Xeljanz?
Tofacitinib (the generic name for Xeljanz) represents a new class of disease-modifying antirheumatic drugs (DMARDs) known as Janus kinase inhibitors. Tofacitinib, approved by the FDA in 2012, works by inhibiting enzymes that contribute to inflammation, thus reducing symptoms like joint pain and swelling. It is prescribed primarily for the treatment of moderate to severe rheumatoid arthritis after methotrexate has proven ineffective or intolerable.
Adalimumab (Humira), on the other hand, is an older type of DMARD called a biologic agent and specifically falls into a category known as tumor necrosis factor-alpha blockers. Approved by the FDA in 2002, Humira targets specific proteins in your immune system to help control inflammation.
While both medications aim at controlling inflammation caused by autoimmune diseases such as rheumatoid arthritis and psoriatic arthritis among others, they work differently within your body’s immune response mechanism which may result in different side effects for patients using either medication.
What conditions is Xeljanz approved to treat?
Xeljanz is approved for the treatment of certain inflammatory conditions such as:
- Rheumatoid arthritis (RA) in adults who have had an inadequate response to or are intolerant of methotrexate
- Psoriatic arthritis (PsA) in adults, after failing or not tolerating methotrexate or other disease-modifying antirheumatic drugs (DMARDs)
- Ulcerative colitis (UC) in adults with moderate to severe active disease who have had an inadequate response to, lost response to, or were intolerant of a tumor necrosis factor blocker.
How does Xeljanz help with these illnesses?
Xeljanz operates by inhibiting the Janus kinase (JAK) enzymes, which are part of the signaling pathway that influences cell growth and immune response. By blocking these enzymes, Xeljanz prevents the overactivity in this pathway, subsequently reducing inflammation and other symptoms associated with autoimmune disorders. This makes it an effective treatment option for conditions like rheumatoid arthritis or psoriatic arthritis.
Humira, on the other hand, works somewhat differently. It is a tumor necrosis factor (TNF) blocker. TNF is a protein produced by your immune system that can cause inflammation when produced in excess or act abnormally as is seen in autoimmune diseases. Humira binds to TNF and blocks its interaction with the body's cells thus preventing inflammatory responses related to this protein.
Both medications aim towards managing symptoms of various inflammatory disorders but operate via different mechanisms within your immune system's processes.
What is Humira?
Humira is a brand name for adalimumab, which is a tumor necrosis factor (TNF) blocker. It works by reducing the effects of TNF, a substance in the body that can cause inflammation and lead to immune system diseases. Humira was first approved by the FDA in 2002.
Humira acts differently from JAK inhibitors like Xeljanz (tofacitinib), as it does not block the action of Janus kinases, enzymes involved in mediating signals for immune response activation. Instead, Humira directly targets and binds to TNF-alpha, a pro-inflammatory cytokine implicated in various autoimmune disorders.
Its side-effect profile also differs from that of JAK inhibitors; while both medications can increase risk of serious infections due to their immunosuppressive properties, common side effects associated with Humira include redness or rash at injection site and headaches.
The specific mechanism through which Humira acts makes it an effective treatment option for several chronic inflammatory conditions such as rheumatoid arthritis or Crohn's disease among patients who do not respond well to traditional DMARDs (Disease-Modifying Antirheumatic Drugs).
What conditions is Humira approved to treat?
Humira is approved for the treatment of a range of conditions, including:
- Rheumatoid arthritis
- Psoriatic arthritis
- Ankylosing spondylitis
- Crohn's disease
- Ulcerative colitis
- Plaque psoriasis.
This medication works by reducing inflammation and preventing further damage to joints or organs by blocking a protein in your body called TNF-alpha which causes inflammation. It is administered via injection and may be used alone or with other medications.
How does Humira help with these illnesses?
Tumor necrosis factor (TNF) is a cell signaling protein involved in systemic inflammation and one of the cytokines that make up the acute phase reaction. Excessively high levels of TNF have been implicated in several autoimmune disorders including rheumatoid arthritis, ankylosing spondylitis, Crohn's disease among others. Humira works by blocking the action of TNF-α, thereby reducing the inflammatory response and alleviating some of these symptoms associated with these conditions. Its role on other inflammatory pathways may also play part in its effectiveness as an anti-inflammatory drug. Since it specifically targets TNF-α, it is often prescribed when a patient does not respond well to non-specific immunosuppressants or JAK inhibitors like Xeljanz or may be combined with them for enhanced effect.
How effective are both Xeljanz and Humira?
Both Tofacitinib (Xeljanz) and Adalimumab (Humira) have established histories of success in treating patients with rheumatoid arthritis, and they were initially approved by the FDA about a decade apart. Since they act on different pathways involved in inflammation, they may be prescribed under different circumstances. The effectiveness of Xeljanz and Humira in alleviating symptoms of rheumatoid arthritis was directly studied in a double-blind clinical trial; both drugs exhibited similar efficacy in managing symptoms as well as similar safety profiles.
A 2013 review reports that Xeljanz is effective at reducing symptoms starting from the first week of treatment, that its side effect profile is comparable to other disease-modifying antirheumatic drugs (DMARDs), and it can be administered orally rather than through injection, which some patients prefer. Further research supports this medication's effectiveness not only for those newly diagnosed but also for those who do not respond to or tolerate methotrexate therapy.
An extensive meta-analysis conducted over several years indicated that Humira seems to significantly alleviate the signs and symptoms of RA compared with placebo when used alone or combined with methotrexate or other nonbiologic disease-modifying antirheumatic drugs. Nonetheless, due to its mode of administration being an injectable drug along with potential serious side effects like infections including tuberculosis and cancers such as lymphoma, careful consideration must be made before starting Humira especially for individuals having latent infectious diseases or risk factors for malignancies.
At what dose is Xeljanz typically prescribed?
Oral dosages of Xeljanz (tofacitinib) range from 5–10 mg twice daily, but it has been shown that a dose of 5mg twice daily is effective for treating rheumatoid arthritis in most adults. Children and adolescents may be started on lower doses based on their weight and disease severity. In either population, the dosage can be increased after some weeks if there is no adequate response. However, the maximum dosage that should not be exceeded under any circumstance is 10 mg twice daily.
On the other hand, Humira (adalimumab) is administered via subcutaneous injection with typical doses being 40mg every other week for adults with rheumatoid arthritis. Some conditions might require weekly injections or higher doses but this will need to be determined by your healthcare provider. It's also used in children over two years old for juvenile idiopathic arthritis but dose adjustments are necessary depending upon weight.
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At what dose is Humira typically prescribed?
Humira treatment for rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis usually begins with a loading dose of 160 mg (four 40 mg injections in one day or two 40 mg injections per day for two consecutive days). The dosage is then reduced to 40 mg given every other week via subcutaneous injection. For moderate to severe Crohn's disease or ulcerative colitis, the initial dose may be doubled to 320mg initially if necessary. If there is no response after a few weeks of therapy at this level, your doctor might consider increasing the frequency of administration rather than discontinuing Humira.
What are the most common side effects for Xeljanz?
Common side effects of Xeljanz can include:
- Upper respiratory tract infections
- Nausea
- Diarrhea
- Headache
- High blood pressure
- Increased cholesterol levels
Compared to Humira, which can lead to:
- Injection site reactions (redness, itching, pain, bruising)
- Upper respiratory tract infections
- Increased risk of serious infections leading to hospitalization or death including tuberculosis (TB), bacterial sepsis and invasive fungal infections.
It's important to remember everyone's body reacts differently to medications. What may cause a side effect in one person may not in another. Always discuss potential side effects with your healthcare provider when starting new medication.
Are there any potential serious side effects for Xeljanz?
Xeljanz, like any medication, may cause potential side effects. These can include:
- Unusual bleeding or bruising
- Signs of infection such as fever, chills, sore throat and difficulty breathing
- Allergic reactions including hives; swelling of the face, lips or tongue; difficulty swallowing
- Chest pain with rapid heartbeat and shortness of breath suggesting heart complications
- Vision changes such as blurred vision or loss of vision which might indicate a neurological event
Additionally, Xeljanz may also lead to some serious conditions that manifest symptoms like severe stomach pain (could suggest gastrointestinal perforation), yellowing eyes/skin (indicative of liver problems) and change in the amount/color of urine (suggestive kidney issues).
If you experience any unusual symptom while on Xeljanz therapy it is important to seek immediate medical attention.
What are the most common side effects for Humira?
Humira, a widely-prescribed medication for conditions like rheumatoid arthritis and psoriasis, may induce some side effects that patients should be aware of. These can include experiences such as:
- Redness, rash or swelling at the injection site
- Headache
- Nausea or abdominal pain
- Sinus infections marked by stuffy nose or sore throat
- Elevated cholesterol levels
- Muscle and joint pain In more severe cases, Humira may lead to symptoms like shortness of breath, rapid heart rate, unusual weight loss and confusion. It's also relevant to note that it could potentially cause issues with your immune system leading to susceptibility towards infections.
Are there any potential serious side effects for Humira?
While Humira has been a life-changing medication for many people, it can cause some serious side effects. If you're taking this drug, be vigilant and look out for the following:
- Signs of an allergic or severe skin reaction: symptoms may include hives, itching, fever, swollen glands, difficulty in breathing or swallowing; swelling in your face or throat; sore throat; burning eyes; skin pain; red or purple skin rash with blistering and peeling
- Nervous system problems such as seizures (convulsions), numbness and tingling sensations
- Changes in vision like blurred vision or double vision
- Heart rhythm abnormalities including fast or irregular heartbeats
- Psychological changes which could manifest as confusion, unusual changes in mood or behavior
- Liver problems characterized by jaundice (yellowing of the eyes and skin); dark urine; loss of appetite leading to rapid weight loss
Always consult your doctor if you experience any of these symptoms while on Humira treatment.
Contraindications for Xeljanz and Humira?
Both Xeljanz and Humira, like other immunosuppressant medications, may worsen symptoms in some individuals. If you notice your condition worsening or an increase of any side effects while taking these medications, please seek immediate medical attention.
Neither Xeljanz nor Humira should be taken if you are currently receiving live vaccines (like the measles, mumps and rubella vaccine) as they can cause serious infections due to their immune-suppressing effect. Always inform your physician which vaccinations or medication you are taking; live vaccines require a period of about 3 months after the last dose to clear from the system before starting treatment with either Xeljanz or Humira.
Furthermore, both drugs have been associated with increased risk of serious infections leading to hospitalization or death including tuberculosis (TB), bacterial sepsis and invasive fungal infections. Prior testing for TB is required before initiating therapy with either drug.
How much do Xeljanz and Humira cost?
For the brand name versions of these drugs:
- The price of 30 tablets of Xeljanz (5 mg) averages around $2,600, which works out to approximately $173/day.
- The average retail price for a single dose pack (containing two pens) of Humira is about $6,240, with recommended dosing every other week. This equates to roughly $446/day.
Thus, if you are in the higher dosage range for Xeljanz (i.e., 10 mg twice daily), then it becomes more expensive on a per-day treatment basis than Humira. However, 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 Xeljanz or Humira in the United States. These medications belong to a class known as biologics and they are typically more complex and costly to manufacture than traditional small-molecule drugs. As such their prices remain relatively high even after exclusivity periods have expired.
Popularity of Xeljanz and Humira
Tofacitinib, commercially known as Xeljanz, has been an increasingly popular prescription for the treatment of rheumatoid arthritis and psoriatic arthritis. In 2020, it was estimated that about 150 thousand patients in the US were prescribed tofacitinib. This drug accounts for approximately 4% of all prescriptions given out to treat these types of arthritis. Tofacitinib has been generally increasing in prevalence since its approval by the FDA in 2012.
Adalimumab, sold under brand names such as Humira, continues to be a dominant player in treating disorders including rheumatoid arthritis and psoriasis among others. It was prescribed to nearly two million people within the USA during 2020 alone. Adalimumab stands at just over 50% of prescriptions for biologics used to manage autoimmune conditions which makes it one of the most commonly utilized drugs within this class. The use of adalimumab remains consistent over recent years due largely to its proven efficacy across multiple indications.
Conclusion
Both Xeljanz (tofacitinib) and Humira (adalimumab) have been shown to be effective in managing autoimmune diseases such as rheumatoid arthritis, psoriatic arthritis, and ulcerative colitis. They work through different mechanisms of action; Xeljanz inhibits enzymes called Janus kinases that play a key role in the inflammatory process, while Humira is a tumor necrosis factor alpha (TNF-α) inhibitor which blocks a protein involved in inflammation.
Xeljanz can be taken orally, offering an advantage over Humira which requires subcutaneous injections. However, both drugs may need some adjustment period when starting or switching from one to another due to their individual pharmacokinetics.
As for side effects, both carry risks including serious infections and malignancies due to their impacts on the immune system. Both medications require regular monitoring by your healthcare provider for potential adverse effects.
In terms of cost effectiveness, generic versions are not available for either drug making them quite costly especially if you're paying out-of-pocket. It's important that patients discuss with their doctors about these therapies taking into consideration factors like cost, convenience of administration and potential side effects before deciding what will best suit their condition.