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: