How Are Enbrel, Remicade, and Humira Similar and Different?

First Three FDA-Approved TNF Blockers

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I asked Scott J. Zashin, M.D., rheumatologist and clinical assistant professor at University of Texas Southwestern Medical School, Division of Rheumatology, about the first three TNF blockers that were FDA-approved. Biologic drugs are becoming more commonly prescribed and it is important to understand the similarities and differences between the various drugs.

Although they are all tumor necrosis factor (TNF) blockers and can produce similar results, each one is a different medication. The one your physician prescribes for you depends on the specifics of your case. Physicians often advise patients to weigh the benefit and risk of any arthritis medication.  

Tumor Necrosis Factor Blockers

Etanercept, infliximab, and adalimumab are all similar in that they are part of a group of immunosuppressant medications called tumor necrosis factor blockers. These drugs are effective in over 70 percent of patients including many who have not responded to methotrexate—considered by many clinicians to be the gold standard of rheumatoid arthritis treatment.

The TNF blockers are a tremendous benefit in the treatment of rheumatoid arthritis and many patients see benefits within two weeks. They can reduce inflammation in the joints and stop the progression of rheumatoid arthritis, by blocking a chemical your immune system produces to cause inflammation.

In addition, TNF blockers are also very effective in relieving the fatigue that is a common symptom of rheumatoid arthritis.

TNF Blockers Are Not Oral Medications

Unlike many commonly prescribed medications, TNF blockers are not effective orally—meaning you can't ingest them as a pill or liquid. Instead, you subcutaneously inject them under your skin at home or go to a clinical facility for an infusion.

As a general rule, you can expect the following dose schedule:

  • Enbrel - subcutaneous injection once or twice a week
  • Humira - subcutaneous injection every other week
  • Remicade -  an intravenous infusion every 4-8 weeks.

Because Remicade is given intravenously, it can be associated with an allergic reaction that can be life-threatening in up to 1 percent of patients.

Side Effects of Enbrel, Remicade, and Humira

Like all medications, TNF blockers have potential side effects. Because they suppress your immune system, one of the most common side effects is an increased risk of infection. These infections can be latent inside your body, including tuberculosis (TB) and the herpes simplex virus. The difference here is that Enbrel is less commonly associated with TB than the other two medications. Irritation at the injection site is also a common side effect for all three medications. It may be accompanied by a rash, itching, or a burning sensation.

Do All TNF Blockers Cost the Same?

The cost of Enbrel, Humira, and Remicade vary, due to a variety of factors.

Compared to other medication, TNF blockers are very expensive. How much it costs you heavily depends on your health insurance coverage. When you take health insurance out of the equation, the cost of a year of Remicade can sometimes be twice as much as that of Humira or Enbrel. Simponi (golimumab) and Cimzia (certolizumab pegol) are two TNF blockers that came along later, but the above considerations apply to them as well.

Answer provided by Scott J. Zashin, M.D., clinical assistant professor at University of Texas Southwestern Medical School, Division of Rheumatology, in Dallas, Texas. Dr. Zashin is also an attending physician at Presbyterian Hospitals of Dallas and Plano. He is a fellow of the American College of Physicians and the American College of Rheumatology and a member of the American Medical Association.

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