How Are Enbrel, Remicade, and Humira Different?

If you have rheumatoid arthritis (RA), it's likely your doctor will prescribe a drug called a TNF inhibitor to help treat your symptoms. Enbrel (etanercept), Humira (adalimumab), and Remicade (infliximab) are three such medications.

Although they belong to the same class of drugs, there are significant differences between Enbrel, Humira, and Remicade.

In this article you'll learn how these drugs work and how they compare in terms of how they're given, how well they work, and what they cost.

How TNF Inhibitors Work

Also known as TNF blockers, TNF inhibitors affect how the immune system responds to a cytokine (a type of protein) called tumor necrosis factor (TNF). This cytokine triggers the inflammation that causes symptoms of RA.

TNF blockers are used to treat a variety of autoimmune disorders. Besides RA, these include psoriasis, psoriatic arthritis (PsA), ulcerative colitis, juvenile idiopathic arthritis, ankylosing spondylitis, and Crohn's disease.

In the case of RA and PsA, TNF blockers work especially alongside methotrexate,a disease-modifying anti-rheumatic drug (DMARD) that also suppresses the immune system.

Administration

An important difference between Enbrel, Humira, and Remicade is how each is given.

This can make a difference for people who are comfortable with giving themselves shots, for example, and would prefer to not have to schedule appointments for infusions.

Effectiveness

TNF blockers are effective in well over 70% of people who have RA. However, they have differing average durations of efficacy. This refers to how long it takes for a medication to become less effective. Once a drug stops working as well as it should, it's usually necessary to switch to a new one.

This is linked to the development of anti-drug antibodies. The risk of limited effectiveness is highest with Remicade, less so with Humira and very rarely noted with Enbrel.

What's more, of the three drugs, Enbrel's average duration of efficacy was especially high for men. The study also found older people on Enbrel were far less likely to change to another TNF biologic.

In considering drugs to change you to if what you are on loses its effectiveness, your doctor may also consider two additional TNF blockers: Cimzia (certolizumab pegol) and Simponi (golimumab).

Cost

Compared to other types of medications for RA, TNF inhibitors are expensive.

Even after factoring in health insurance co-payments, retails discounts, and patient assistance programs, you can expect the overall price of these drugs to fall more or less within these ranges:

• Humira: $1,800 to $2,400 per month
• Enbrel: More than $4,000 per month
• Remicade: A single dose can cost from $1,250 to $2,500, depending on whether doses are given every four weeks or eight weeks.

It's worth factoring in the cost of each drug as you and your doctor decide which one you will try.With Remicade, it's also important to factor in the cost of having your medication administered at a hospital. If you give yourself Enbrel or Humira, you obviously will not need to consider this expense.

Income often plays a role in how much these medications will cost per month, and below a certain threshold, many patients can get these medications at very reduced cost or for free.

Summary

If you have rheumatoid arthritis, it's likely your doctor will want to prescribe a TNF inhibitor for you. Overall, these drugs are safe and effective, but there are a few factors to consider.

If you are deciding between Enbrel, Humira, and Remicade, the key things to think about are how each drug is given and how long each one will work for you before you need to switch to different medication. Enbrel and Humira typically stay effective longer than Remicade.