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Xeljanz vs Otezla
Introduction
Xeljanz and Otezla are two medications prescribed for specific autoimmune disorders such as rheumatoid arthritis, psoriatic arthritis, and plaque psoriasis. Both drugs work by regulating the immune system's response that leads to inflammation and damage in the joints or skin cells.
Xeljanz is a Janus kinase (JAK) inhibitor that works by blocking enzymes known as JAKs which play a crucial role in the inflammatory processes of these diseases. On the other hand, Otezla operates differently — it’s classified as a phosphodiesterase 4 (PDE4) inhibitor. It reduces inflammation by lowering levels of cyclic adenosine monophosphate (cAMP), a molecule involved in various immune responses.
While both help manage symptoms effectively, they exhibit different side effects profiles due to their distinct mechanisms of action. Consulting with your healthcare provider will be essential to weigh potential benefits against possible risks when choosing between these treatments.
Xeljanz vs Otezla Side By Side
| Attribute | Xeljanz | Otezla |
|---|---|---|
| Brand Name | Xeljanz | Otezla |
| Contraindications | Should not be taken with immunosuppressants or biologics without consulting a doctor. Not recommended for people who have had tuberculosis, hepatitis B/C, lymphoma, or other cancers. | Should not be taken with immunosuppressants or biologics without consulting a doctor. Caution advised for patients with a history of depression or suicidal thoughts. |
| Cost | $5300 for a 30-day supply | $3300 for a one-month supply |
| Generic Name | Tofacitinib | Apremilast |
| Most Serious Side Effect | Increased risk for serious infections such as tuberculosis, and other bacterial, viral, or fungal infections; severe liver disease. | Severe allergic reactions, severe diarrhea, nausea, vomiting leading to dehydration, unusual weight loss or gain, mood changes and depression. |
| Severe Drug Interactions | Negative interactions when taken with other immunosuppressants or biologics. | Specific interactions not detailed, but caution is advised when combined with other systemic treatments for psoriasis or psoriatic arthritis. |
| Typical Dose | 5 mg twice daily for rheumatoid arthritis, psoriatic arthritis, or ankylosing spondylitis. 10 mg twice daily for ulcerative colitis for at least eight weeks, then possibly reduced to 5 mg twice daily. | Titration starting at 10 mg on the first day, increasing to a maintenance dose of 30 mg twice daily. |
What is Xeljanz?
Tofacitinib (the generic name for Xeljanz) was the first drug of the JAK inhibitors class, which marked a significant progression from the traditional immunosuppressive medications. Tofacitinib was initially approved by the FDA in 2012. Xeljanz works by inhibiting enzymes known as Janus kinases that play a crucial role in immune and inflammatory responses leading to conditions like rheumatoid arthritis and psoriasis. It is prescribed for several autoimmune disorders such as rheumatoid arthritis, psoriatic arthritis, and ulcerative colitis.
On the other hand, Apremilast (the generic name for Otezla), while used to treat similar conditions, functions differently by inhibiting an enzyme called phosphodiesterase 4 (PDE4). This mechanism of action results in decreased inflammation within cells. Approved by the FDA in 2014, it has been shown effective against plaque psoriasis and psoriatic arthritis.
Both drugs have side effects; however, Xeljanz's selective inhibition of specific JAK pathways often leads to fewer adverse effects compared with Otezla's broader enzymatic inhibition.
What conditions is Xeljanz approved to treat?
Xeljanz is approved for the treatment of several autoimmune diseases:
- Rheumatoid arthritis, which causes pain, swelling, and stiffness in joints
- Psoriatic arthritis, a type of arthritis that affects some people who have psoriasis
- Ulcerative colitis (UC), an inflammatory bowel disease that results in long-lasting inflammation and sores (ulcers) in the innermost lining of your large intestine (colon) and rectum.
Meanwhile Otezla is approved for:
-Psoriasis -Psoriatic Arthritis
How does Xeljanz help with these illnesses?
Xeljanz helps to manage rheumatoid arthritis by inhibiting Janus kinase enzymes, which are involved in the inflammatory process. It does this by blocking their activity, so inflammation can be controlled and maintained at lower levels for extended periods of time. Inflammatory responses play a significant role in joint pain, stiffness, swelling and eventual damage associated with conditions like rheumatoid arthritis. It is thought that individuals with rheumatoid arthritis have abnormally high levels of these inflammatory processes going on within their joints. Therefore, by reducing inflammation through Janus kinase inhibition, Xeljanz can limit the negative effects of rheumatoid arthritis and help patients manage their condition and improve mobility.
What is Otezla?
Otezla, the brand name for apremilast, is a phosphodiesterase 4 (PDE4) inhibitor. This means it works by increasing levels of cyclic adenosine monophosphate (cAMP) in the body to reduce inflammation. It does this by blocking an enzyme called PDE4 that breaks down cAMP. Otezla was first approved by the FDA in 2014.
Unlike Xeljanz, which is a Janus kinase inhibitor and targets specific pathways within the immune system to stop inflammation, Otezla doesn't inhibit tumor necrosis factor (TNF), interleukin-17 (IL-17), or interleukin-23 (IL-23). This lack of action on these cytokines changes its side-effect profile compared to drugs like Xeljanz - it does not require regular blood monitoring and has no black box warning for serious infections or malignancies.
Common side effects may include diarrhea and weight loss but are typically mild to moderate and tend to decrease over time as treatment continues. The unique mechanism of action can be beneficial especially for patients who have not responded well or have contraindications with other typical treatments such as biologics or TNF inhibitors.
What conditions is Otezla approved to treat?
In the United States, Otezla has been approved by the FDA for three primary indications:
- Psoriatic arthritis: This is a condition where individuals suffer from both psoriasis and arthritis.
- Moderate to severe plaque psoriasis: Here, it is specifically intended for patients who may be eligible for phototherapy or systemic therapy.
- Oral ulcers associated with Behçet’s Disease: A rare and chronic multisystem inflammatory disorder.
How does Otezla help with these illnesses?
Phosphodiesterase 4 (PDE4) is an enzyme that plays a crucial role in the inflammatory response in our body, affecting various processes such as immune cell activation and cytokine production. High levels of PDE4 activity have been associated with conditions like psoriasis or rheumatoid arthritis. Otezla works by inhibiting the action of PDE4, thereby reducing inflammation and alleviating some symptoms related to these conditions. Its unique action on this specific pathway makes it different from other treatments like Xeljanz which targets Janus kinases instead. Because it does not significantly affect the immune system's overall function, Otezla is sometimes prescribed when a patient does not respond well to typical DMARDs (Disease Modifying Antirheumatic Drugs), or may be combined with them for better results.
How effective are both Xeljanz and Otezla?
Both tofacitinib (Xeljanz) and apremilast (Otezla) have been proven effective in managing symptoms of moderate to severe plaque psoriasis, with both drugs having received FDA approval within a few years of each other. These two treatments operate through distinct mechanisms: Xeljanz is a Janus kinase inhibitor while Otezla inhibits phosphodiesterase 4.
Clinical trials comparing the effectiveness of Xeljanz and Otezla directly are lacking; however, each drug has demonstrated efficacy in separate studies. A 2015 study showed that patients receiving Xeljanz experienced significant improvements in their Psoriasis Area Severity Index scores compared to those on placebo. Similarly, separate clinical trials for Otezla reported comparable results regarding symptom improvement.
A 2018 meta-analysis report on Xeljanz pointed out its effectiveness starting from the second week of treatment, favorable side effect profile over some traditional systemic therapies for psoriasis like methotrexate or cyclosporine, and good tolerability even among elderly populations. The same study noted that dosages showing optimal efficacy typically range between 5-10 mg twice daily.
On the other hand, as per a review conducted in 2016, it was found that Otezla seems more effective than placebo at treating psoriatic arthritis but similar in efficacy when compared to some conventional DMARDs like sulfasalazine or leflunomide. Still considered an alternative treatment option after first-line therapies such as TNF inhibitors fail or aren't tolerated well by patients due to potential side effects such as gastrointestinal upset or weight loss.
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At what dose is Xeljanz typically prescribed?
Oral dosages of Xeljanz (tofacitinib) for rheumatoid arthritis, psoriatic arthritis, or ankylosing spondylitis are typically 5 mg twice daily. For ulcerative colitis, the typical dosage is 10 mg twice daily for at least eight weeks; after this period, the dosage may be reduced to 5 mg twice daily depending on response. Children and adolescents should only use Xeljanz under a doctor's supervision with the dose being determined by their healthcare provider. In contrast, Otezla (apremilast) is usually prescribed as one 30mg tablet taken orally twice a day irrespective of diagnosis - psoriasis or psoriatic arthritis. The maximum dosage that should not be exceeded in any case is two tablets per day (60mg total). It's important to note that these medicines have different mechanisms of action and potential side effects so it's crucial to consult your healthcare provider about which one may be better suited for you.
At what dose is Otezla typically prescribed?
Otezla therapy typically commences with a titration phase, starting with a 10 mg dose on the first day. The dosage is then gradually increased over the course of five days until it reaches a regular maintenance dose of 30 mg twice daily. This dosing schedule splits into two doses, taken approximately 12 hours apart each day. If satisfactory results are not achieved after several weeks at this level, your doctor may reassess your treatment plan. The maximum recommended dose for Otezla is 60 mg/day divided into two doses of 30 mg and spaced roughly twelve hours apart.
What are the most common side effects for Xeljanz?
Common side effects of Xeljanz can include:
- Upper respiratory tract infections
- Headache
- Diarrhea
- Nasopharyngitis (inflammation of the nose and throat)
- Hypertension (high blood pressure)
- Elevated liver enzymes
- Hyperlipidemia (high levels of fats in the blood)
While Otezla side effects often include:
- Diarrhea
- Nausea
- Upper respiratory tract infection
- Tension headache
- Abdominal pain
- Vomiting
Remember to always consult with a healthcare provider for personalized advice concerning medications.
Are there any potential serious side effects for Xeljanz?
With Xeljanz, there are rare but potentially severe side effects that can occur:
- Increased risk for infections such as tuberculosis and other bacterial, viral or fungal infections
- Signs of allergic reaction: hives; difficulty breathing; swelling in your face, lips, tongue or throat.
- Unusual changes in mood or behavior including feelings of depression
- Changes in vision
- Rapid heart rate, feeling anxious or nervous
- Low red blood cell (anemia) levels - symptoms include pale skin, unusual tiredness and shortness of breath.
- Severe liver disease - nausea and vomiting, itching, loss of appetite, dark urine coloration and jaundice.
If you experience any of these side effects with Xeljanz usage please contact your healthcare provider immediately. It's also important to note that while both Otezla and Xeljanz treat conditions like psoriasis arthritis they work differently & hence the side effect profiles differ. Always discuss risks versus benefits with your doctor when choosing a medication.
What are the most common side effects for Otezla?
When comparing Xeljanz to Otezla, it's crucial to highlight the potential side effects of Otezla. These may include:
- Diarrhea, nausea, and vomiting
- Headache or tension headache
- Upper respiratory tract infection symptoms such as stuffy nose and sore throat
- Tiredness or fatigue
- Decreased appetite leading potentially to weight loss
- Insomnia or problems with sleep
- Depression or mood changes Skin rash In more rare cases, some individuals may experience a fast heartbeat. As always, if you're considering taking Otezla for your condition, consult with your healthcare provider first about any potential risks and benefits.
Are there any potential serious side effects for Otezla?
While Otezla is generally well-tolerated, it's essential to be aware of potential side effects. Serious adverse reactions may include:
- Indications of a severe allergic reaction: such as hives; difficulty breathing; swelling in your face, lips, tongue or throat
- Unusual weight loss or gain
- Symptoms suggestive of mood changes and depression like feeling hopeless or suicidal thoughts
- Severe diarrhea, nausea and vomiting leading to dehydration indicated by dizziness, lightheadedness and increased thirst
- Frequent infections due to low white blood cell count presenting with fever, flu-like symptoms, mouth sores and unusual tiredness
If you experience any of these concerning symptoms while taking Otezla, seek immediate medical attention.
Contraindications for Xeljanz and Otezla?
Both Xeljanz and Otezla, along with most other medications for autoimmune disorders, may worsen symptoms in some people. If you notice an increase or worsening of your symptoms such as fatigue, weakness, coughing up blood/mucus or unexplained weight loss while taking these drugs you should notify your healthcare provider right away.
Neither Xeljanz nor Otezla should be taken if you are currently using any type of immunosuppressants or biologics without discussing it first with your doctor. These medications have the potential to interact negatively causing health complications. Always inform your physician about all the medications that you are taking; certain drugs will require a washout period to clear from your system before starting therapy with either Xeljanz or Otezla.
People who have had tuberculosis (TB), hepatitis B/C infection, lymphoma or other cancers should not take either medication until consulting their healthcare provider due to an increased risk of reactivation of these conditions.
How much do Xeljanz and Otezla cost?
For the brand name versions of these drugs:
- The price for a 30-day supply (60 tablets) of Xeljanz (tofacitinib, 5 mg twice daily) averages around $5300, which works out to approximately $176/day.
- The cost for a one-month supply (30 tablets) of Otezla (apremilast, 30 mg twice daily after initial titration), is typically about $3300, working out to roughly $110/day.
This suggests that if you are prescribed either medication at their typical dosages, then Xeljanz will be more expensive on a per-day treatment basis. However, it's important to remember that cost should not be your primary consideration in determining which drug is right for you. Both medications have different side effect profiles and may work differently based on your individual health condition.
As far as generic versions go:
- Currently there is no generic version available for either Xeljanz or Otezla. These medications are still under patent protection in the United States so costs remain high. It’s always worth discussing with your healthcare provider about any potential patient assistance programs offered by the pharmaceutical companies or possible alternatives if affordability becomes an issue.
Popularity of Xeljanz and Otezla
Tofacitinib, marketed under the brand name Xeljanz among others, is widely used to treat rheumatoid arthritis (RA), psoriatic arthritis (PA), and ulcerative colitis. In 2020, it was estimated that about 200 thousand people in the US were prescribed Tofacitinib. This medication accounted for just over 13% of prescriptions for DMARDs (disease-modifying antirheumatic drugs) in the US.
Apremilast, sold under the brand name Otezla among others, is primarily used to treat psoriasis and psoriatic arthritis. It was prescribed to approximately 300 thousand people in the USA in 2020. This accounts for nearly 20% of all prescriptions specifically aimed at treating Psoriatic Arthritis and around half as many overall prescriptions as Tofacitinib when considering all conditions treated by these two medications.
Though both are popular choices within their respective classes of medication and both have been increasing slowly but steadily since their introduction into the market, they serve slightly different patient populations based on their indications.
Conclusion
Both Xeljanz (tofacitinib) and Otezla (apremilast) have proven efficacy in managing autoimmune conditions such as psoriatic arthritis, rheumatoid arthritis, and plaque psoriasis. Supported by clinical studies and meta-analyses demonstrating their effectiveness surpassing placebo treatments, these drugs are commonly used when first-line treatment options prove ineffective or inadequate. The distinct mechanisms of action make them useful under different circumstances: Xeljanz primarily inhibits janus kinases (JAKs), thereby modulating the immune response; whereas Otezla selectively targets an enzyme called phosphodiesterase 4 (PDE4), controlling inflammation.
Xeljanz is typically used when patients haven't responded well to methotrexate or other disease-modifying antirheumatic drugs (DMARDs). On the other hand, Otezla might be considered for those who want a medication that doesn't require regular laboratory monitoring or for those with concomitant moderate to severe plaque psoriasis.
While not available in generic form yet due to patent protections, financial assistance programs may help offset costs for eligible patients. Both medications may take some time before their full effects become evident.
In terms of side effect profiles, both are generally well-tolerated. However, each carries its own unique risks: Xeljanz can potentially increase susceptibility to serious infections while Otezla may lead to weight loss and mood changes including depression. As with any medication regimen, it's crucial for patients starting on either drug to monitor their symptoms closely and consult health professionals promptly if they notice worsening symptoms or unexpected side effects.
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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
- Irving, P. M., Leung, Y., & Dubinsky, M. C. (2022, August 22). Review article: guide to tofacitinib dosing in patients with ulcerative colitis. Alimentary Pharmacology & Therapeutics. Wiley.http://doi.org/10.1111/apt.17185
- Scott, L. J. (2013, May 29). Tofacitinib: A Review of its Use in Adult Patients with Rheumatoid Arthritis. Drugs. Springer Science and Business Media LLC.http://doi.org/10.1007/s40265-013-0065-8
- 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
- Paik, J., & Deeks, E. D. (2019, March 20). Tofacitinib: A Review in Psoriatic Arthritis. Drugs. Springer Science and Business Media LLC.http://doi.org/10.1007/s40265-019-01091-3
- Sakkas, L. I., Mavropoulos, A., & Bogdanos, D. P. (2017, September 25). Phosphodiesterase 4 Inhibitors in Immune-mediated Diseases: Mode of Action, Clinical Applications, Current and Future Perspectives. Current Medicinal Chemistry. Bentham Science Publishers Ltd.http://doi.org/10.2174/0929867324666170530093902