Enbrel or Humira

Now that I’m reconciled to taking a biologic, I’m kinda wishing I’d just done it already.  If it works, I’ll get to discontinue plaquenil and sulfasalazine, which would eliminate eight pills every day!

The rheumy said either Enbrel or Humira.  I’ve been searching, and found this gem:

“Etanercept is produced by recombinant DNA technology in a Chinese hamster ovary (CHO) mammalian cell expression system. It consists of 934 amino acids and has an apparent molecular weight of approximately 150 kilodaltons.”
RxList

Chinese Hamster Ovary Cells?  Alrighty then.  That’s not exactly what I was hoping for when I set out to learn about Enbrel.

The rheumatologist gave me a little brochure that was supposed to contain information to help me choose between Enbrel and Humira, but it wasn’t the least bit helpful.  For one, it mentions Enbrel and Remicade, not Humira.  And it’s pretty dated.  With an opening statement that there are now two biologics approved for use in treating RA (I thought there were 8-9 with more in the works), I looked for a copyright and discovered that the brochure was nearly ten years old.

I’ve checked a few places online, and have summarized below what I’ve learned so far that seems pertinent.  Actually, I moved it to the bottom of the post, because although it was helpful when I was looking for information, now it all sounds pretty boring.

What it comes down to is that it sounds like they’re pretty comparable medications, but Chinese hamster ovary cells are needed to produce Enbrel; not for Humira.  I don’t think this is sufficient data for making an informed decision.  I might as well flip a coin.  If I could!

I’m not concerned about the possible side effects.

  • With meds:  likely to have more energy and the pain-free use my hands/wrists/elbows/shoulders/knees/feet.  Delay (hopefully halt) joint deterioration and deformity.  Chance at a semi-normal life
  • Without meds:  continued and worsening pain, extreme fatigue, probable joint deterioration and deformity, likely to need a wheelchair within 10 years (difficult in my 2-story house), small increase in the possibility of malignancies (still much less than 1%)

One advantage to Enbrel is that it has a longer track record.  One advantage to Humira is that it would mean half as many shots.  I’m still looking into the $ aspect.

Thank you, again to those of you who shared your experiences with me.  Based on what people have shared, I’m leaning toward Enbrel.

If you write about your experience with these biologics, I will gladly link your blog.
Please drop me a line.

***

General information comparing these biologics:

All vaccines should be updated prior to beginning Enbrel (the doctor didn’t mention that).  No live vaccines with either Enbrel or Humira, but annual flu shots should be fine.  I’m guessing that means I should get the chicken pox vaccine first, but I probably won’t.  And I think it’s about 13 years since my last tetanus shot, so I probably ought to get that one!

Both Enbrel and Humira are clear, colorless liquids that are injected subcutaneously.

Both Enbrel and Humira are used to treat RA, JIA, AS, PsA, and Plaque Psoriasis.  Humira is also used to treat Crohn’s.

Both Enbrel and Humira come in various forms, including pre-filled syringes and easy-to-use injector pens.  These things are easy to self-administer.

Both Enbrel and Humira should be stored in the refrigerator (not freezer) in the original carton until time to use.  Enbrel can be brought to room temperature before injecting, which is reported to lessen the sting.

The most common side effect reported by companies trying to sell both of these drugs is a mild reaction at the injection site.  OTOH, patients have had a few choice words about those injection-site reactions.  I guess the definition of a “mild reaction” depends on whether or not you’re the one experiencing it.

Since both of these drugs suppress the immune system, it should come as no surprise that people taking these medications can get infections.

Both Enbrel and Humira can be used alone, or as combination therapy with other DMARDs.  HOWEVER, Enbrel and Humira are TNF blockers; taking a TNF blocker with Kineret (an interleukin-1 receptor antagonist) increases the risk of infection.

It was once thought that this drug increased the incidence of lymphomas, then new evidence suggested that severe RA disease activity, not TNF blockers (or even DMARDs), is the risk.  According to the RxList information on these drugs, RA increases the chance of lymphoma 3-7 times the general population.  However, don’t panic because the risk is still incredibly small (less than 0.1%).

I’ve heard much about the increased risk of tuberculosis with the use of TNF-blockers, but it appears that the incidence of TB in RA patients worldwide is 0.01%, and 0.007% in the U.S. and Canada.  That doesn’t sound like a very big risk!  Plus, you’re tested for TB (and treated if positive) before beginning this med.

A new look at the data indicates that TNF-blockers might be associated with an increase in the risk of leukemia and new-onset psoriasis.  The FDA has required a new boxed warning about these risks.

Enbrel is injected weekly.  Humira is injected every-other-week.

Enbrel was approved November 2, 1998.  Humira was approved December 31, 2002.

A few places to look for further reading:

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8 thoughts on “Enbrel or Humira

  1. You have a tough decision to make, and it sounds like you’re learning a lot. I’m glad you’re feeling better about taking a biologic and have heard so much from so many people.

    I find Enbrel very easy to administer. I use the once-weekly prefilled syringes (but not the SureClick). It’s nice not having to mix it myself anymore.

    Chinese hamster ovaries – now that is something I didn’t know!

  2. I can’t say anything about Humira, having no experience with it. But Enbrel is good for me. I also use the pre-filled 50 mg syringe, not the SureClick – so I can control the shot. I’ve not experienced any infections or other side effects on Enbrel, just an occasional injection site reaction, which I would describe as very mild. There are some tricks to making the injection more tolerable, but it is an injection. And Enbrel is my only therapy, aside from naproxen – no malaria drugs or chemotherapy meds for me.

    Whatever you decide, keep us posted.

  3. I have a friend with Type 2 diabetes who injects insulin several times a day. It typically burns and stings upon injection, so she uses a lidocaine gel and also ices the injection site for 10 minutes or so beforehand. Both make the ordeal a lot less painful for her.

    Thanks for sharing your research with us, WarmSocks. I still have several DMARDs to “fail” before biologics become a part of my life (I hope to “pass”, actually), but in either case it’s good to be informed. I hope you’ll be able to start your choice of bios soon and that it will be successful in controlling your pain.

    Have a wonderful Sunday!

  4. Oh — I just thought of this question. Perhaps you know the answer. DMARDs — “Disease Modifying” drugs — have as a main function slowing or arresting the progression of RA, and in so doing (the theory goes) also reducing inflammation and pain. Do biologics also do this as their main purpose? Probably a silly question, but hey. Might as well ask.

    • Biologic Response Modifiers (BRMs) are also known as biologic DMARDs.

      From medicine.net

      TNF-alpha is a protein that the body produces during the inflammatory response, the body’s reaction to injury. TNF-alpha promotes the inflammation and its associated fever and signs (pain, tenderness, and swelling) in several inflammatory conditions including rheumatoid arthritis and ankylosing spondylitis. Etanercept is a synthetic (man-made) protein that binds to TNF-alpha. It thereby acts like a sponge to remove most of the TNF-alpha molecules from the joints and blood. This prevents TNF-alpha from promoting inflammation and the fever, pain, tenderness and swelling of joints in patients with rheumatoid or psoriatic arthritis and ankylosing spondylitis.

      TNF = tumor necrosis factor

    • One pretty readable summary includes this info:

      In general, biologics are genetically engineered medication made from a living organism, such as a virus, gene or protein, and then used to treat a problem occurring in a different organism, such as a human. Vaccines are one type of biologic agent. In contrast, other drugs are synthesized chemicals.

      …Because the biologics block triggers of inflammation, they are used to treat autoimmune forms of arthritis…

      Although the goal of biologics is the same – to stop damaging inflammation – they interrupt the complex cascade of cellular events that drive inflammation at different stages.

      For instance, adalimumab (Humira), etanercept (Enbrel) and infliximab (Remicade) each prevent the production of tumor necrosis factor alpha (TNF-a) – a protein produced by cells of the immune system to induce inflammation.

      Anakinra (Kineret), on the other hand, inhibits production of the chemical called interleukin-1 (IL-1), which is involved in the bone damage that occurs when joints are damaged by RA. As an IL-1 inhibitor, it can help prevent erosion of bones.

      Rituximab (Rituxan) stops the activation of a certain type of white blood cell called B cells. With fewer B cells, the overactivity of the immune system decreases.

      Abatacept (Orencia) is a selective costimulation modulator that blocks a particular chemical that triggers the overproduction of T cells.

      Other biologics are being developed against other targets. These future biologics, which may block not only TNF-a, but also other inflammatory proteins, such as interleukin-6, will expand treatment options.

      Click here to read the whole article.

      HTH

  5. I’m not going to try to make this comment “gel;” instead, I’m just going to make observations in random order. Here goes:

    1. I knew about the Chinese hamster ovaries, but it didn’t bother me. It made me look twice, but it didn’t bother me.

    2. My doctor suggested Enbrel as the first one to try because she was more comfortable with the fact that it had been around the longest. All the BRMs seemed “dangerous” to me, but I concurred.

    3. Prior to starting Enbrel, I got the Shngles vaccine even though I’m kinda young for it. Shingles can be a life-long painful affliction. I figured, “I already have RA. If I can avoid getting something else with one simple shot, I’m all for it.” I do get flu shots every year, since they’re “dead” vaccines.

    4. Re: cost. Right now, Enbrel and Humira are roughly equivalent in cost if you take Enbrel once a week and Humira once every other week. If, however, you find that you need to use Humira twice a week (and this does happen), that will double your cost, making the Humira much more expensive.

    HTH!

  6. Pingback: Patient Assistance « ∞ itis

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