How Are Enbrel, Remicade, and Humira Different?

Key Differences in Efficacy, Cost, and Administration


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TNF inhibitors (also known as TNF blockers) are a class of drugs that reduce inflammation by tempering the immune response. They are used to treat a variety of autoimmune disorders, including rheumatoid arthritis (RA), psoriasis, psoriatic arthritis, ulcerative colitis, and Crohn's disease.

The three of the more popular TNF inhibitors used to treat RA are:

While all three drugs suppress the body's response to tumor necrosis factor (TNF)—a type of protein, called a cytokine, which triggers inflammation—each has a different chemical structure as well as specific benefits and limitations.

How TNF Inhibitors Work

TNF inhibitors are a type of biologic drug used to treat autoimmune diseases like RA. While they specifically target TNF, other biologics target cytokines such as interleukin or alter the way in which immune cells (called T-cells or B-cells) function.

TNF inhibitors have become increasingly important tools in the management and treatment of RA since their introduction in 1998. They are effective in well over 70 percent of people living with the disease, including those who have not responded to first-line methotrexate therapy.

When used in combination with methotrexate, TNF inhibitors are known to be even more effective at restoring the quality of life of RA sufferers, often in as short as 12 weeks.

Differences in Administration

While the mechanism of action is more or less the same for all three drugs, Enbrel, Humira, and Remicade have a number of key differences. Chief among them is the administration of the drugs and the frequency of dosing.

While there can be variations in how the drugs are used, they are generally prescribed as follows:

  • Enbrel is delivered by subcutaneous injection (into the skin) once or twice a week.
  • Humira is delivered by subcutaneous injection every other week.
  • Remicade requires an intravenous infusion every four to eight weeks.

Moreover, unlike Remicade, Enbrel and Humira can be self-administered by a dosage-controlled. Injectable pen (such as those used by diabetics to inject insulin).

Differences in Efficacy

Another way in which the drugs differ is the average duration of efficacy, meaning the amount of time you can use them before you need to change treatment.

To this end, a study conducted in 2013 by scientists at the University of Valladolid in Spain investigated the average treatment duration of Enbrel, Humira, and Remicade in 91 people with RA.

What they found was that both Enbrel and Humira had a duration of efficacy of over seven years (2,561 days and 2,769 days, respectively). By comparison, Remicade had an average treatment duration of just over five years (1,853 days).

Of the three drugs, Enbrel demonstrated the highest duration of efficacy, particularly among women who stayed on treatment for an average of almost nine years (3,191 days). Moreover, older people on Enbrel were far less likely to change to another TNF biologic.

While the conclusions are limited by the scale of the study, the researchers concluded that, of the three TNF inhibitors, Enbrel demonstrated clear superiority.

Differences in Cost

TNF inhibitors are all very expensive compared to other RA drugs, the issue of which is relevant to your treatment.

While the affordability of the drugs may be improved after factoring in insurance co-payments, retail discounts, and patient assistance programs, you can expect the overall price to fall more or less within these ranges:

  • Humira cost between $1,800 and $2,400 per month.
  • Enbrel averages more than $4,000 per month.
  • A single dose of Remicade can cost anywhere from $1,250 to $2,500, depending on whether you need a shot every four weeks or eight weeks.

With Remicade, it is also important to factor in the hospital infusion costs. By contrast, Enbrel and Humira wouldn't incur these costs if you decide to self-inject.

In the end, the true cost of treatment will be dependent on your insurance coverage and your eligibility for co-payment assistance as offered by the manufacturers of Enbrel, Humira, and Remicade.

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Article Sources

  • Marti­nez-Santana, V,; Gonzalez-Sarmiento, E.; Calleja-Hernandez, M. et al. "Comparison of drug survival rates for tumor necrosis factor antagonists in rheumatoid arthritis." Patient Prefer Adherence. 2013; 7:719-27. DOI: 10.2147/PPA.S47453.