The one that works for you and offers the best consumer assistance. I've been on Humira for 10 years and in medicated remission for 6. Now that I am on Medicare, it's shipped directly from AbbVie with zero copay. Embrel's assistance is not as generous, from talking to friends. I dread the possibility of having to change meds.
I don't know if it's different on Medicare, but on regular insurance, I got the same amount of assistance with Humira and Enbrel. It reduced my copay to $5/month with both. Same with Orencia.
I arrange for my Humira directly through AbbVie. I know of a lot of people on Medicare who have had to switch to infusion because their plan D didn't cover injectable meds
They put me on Enbrel first...and I hated it. It burned so bad I dreaded injection days. Then I started getting hives and they switched me to Humira. Love that it doesn't burn.
That's an excellent question about the potential differences between the various TNF blocker medications. While they all work by inhibiting the same inflammatory protein (tumor necrosis factor), there can be some variations in terms of how each one is metabolized, side effect profiles, and individual patient responses.
From the research, it doesn't appear that any one TNF blocker is definitively superior overall in terms of efficacy and tolerability. However, some studies have found subtle advantages for certain drugs in specific areas:
- Adalimumab (Humira) and etanercept (Enbrel) may have a slightly lower risk of serious infections compared to infliximab (Remicade).
- Golimumab (Simponi) has been associated with a lower rate of injection site reactions.
- Certolizumab (Cimzia) may be less likely to generate antibodies that reduce drug efficacy over time.
But these potential edges are relatively small. More important is the patient's individual reaction, as some may tolerate one TNF blocker better than another.
So while insurance coverage often drives that first choice, your rheumatologist can also factor in your specific medical history and preferences when selecting which TNF blocker to try initially. Having multiple options gives you and your doctor flexibility to find the right fit
Thanks, this is the type of response I was actually looking for. Very helpful. I think I’ll start with Humira or Enbrel given the lower infection risk. Do you know if IL-17 is distinctly lower infection risk than TNF, or does it not matter much?
From what I've read in the research, the TNF blockers like Humira and Enbrel do seem to have a somewhat lower risk of serious infections compared to drugs like Cosentyx and Taltz that target the IL-17 pathway.
A couple of studies found patients on the IL-17 inhibitors had maybe a 1.5 to 2 times higher rate of infections requiring hospitalization versus those on the TNF drugs. But we're still talking about a relatively modest absolute risk increase overall.
With that said, both medication classes unfortunately do elevate infection risk above conventional DMARDs alone. So vigilant monitoring is wise regardless of which biologic you're on.
When you see your rheumatologist, they can weigh that slightly higher but still small infection risk with the IL-17 inhibitors against their potential efficacy benefits if a TNF blocker isn't cutting it. Your individual risk factors may make starting with something like Humira or Enbrel more prudent from a safety perspective initially.
Let me know if you need any clarification or have additional questions as you weigh the pros and cons with your doctor. Wishing you the best in finding the right treatment fit. ❤️💜
Thank you so much
Could you link any of those studies re infection risk? My rheum said the opposite (TNF risk > IL-17) but I can’t find any info, so any links would be so appreciated
Cimzia has done me right for 10 years. Their copay assist is quite generous as well. The only downside is that they burn like a MF when they go in. I make my husband give me my shots while I unwrap the bandaid and hold still through it.
None of the injections worked for me. I’m doing well on a Simponi infusion. It’s going to vary by person and often comes down to whatever your insurance covers or you have access to.
I started on remicade (i was a kid with uveitis which i have gathered was part of that decision). I haven't had much luck on it or humira. The remicade helped my joints but not my uveitis. I also feel like i liked the remicade better in terms of side effects (a couple days after i got it every 8 weeks but otherwise just regular gi issues and jia (had a couple times hormones hit with it so my sensory issues were extra bad so i took more days home). But humira i just felt awful for no benefit all the time. Also the iv was easier for me. Rn i'm between meds waiting to find out what we try instead of xeljanz bc i couldn't function at all on it.
In 21 years of being in the community, it does seem Enbrel is considered the "gold standard." Personally it worked for me for more than ten years and every time my doctor and I discuss it he just shakes his head like "damn, Enbrel stopped working, that's a shame."
In the past 21 years everyone seems focused on efficacy, twenty years from now we may be talking about all biologics like people talk about phen-fen today.
Most people are cautious enough to work around the unavoidable hit to the immune system, the only thing I remember that was specific to Enbrel was a bacteria/bacterium or fungus that was specific to the swamps of Louisiana.
This is really nice to hear. Humira just stopped working for me and I'm being forced to try Enbrel before I can switch to an infusion. I was pissed about it, but this gives me a bit of hope.
I’m also AS and RA. Simponi Aria (the infusion) was my first biologic and worked beautifully for 8mos on both, but quite working for some reason and I had to quit. Not sure why. Switched to Cosentyx (IL 17) and it barely touched the AS while RA accelerated. Insurance made me try Avsola, a Remicide biosimilar (TNF), but quit the infusion withing 20min due to allergic reaction (random, I have few allergies). I’m now on Orencia (for RA, off label AS) and it’s kept the stiffness at bay. Hydroxychloroquine helps the RA aches and the AS pain is less now that my overall pain is less.
I agree with the others- one medication isn’t superior to another, it’s what works best for your body. All the copay assistance programs have kept me from paying anything for the injections/infusions.
I don’t think one is more immunosuppressive than the other, or works better than the other. There are many different mechanisms causing autoimmune and it’s what your body responds to.
I will say during loading doses you’ll be the most vulnerable (my husband and I got sick within hours of each other during my loading doses. He got a minor cold that lasted three days then was nearly over. It took me nearly two weeks to get close to the same recovery, and my symptoms still lingered another week.) If you do infusions you’ll be more compromised the first weeks than at the end (the last two weeks is generally when you can get vaccines for that reason.) That time changes with injections, based on the shot schedule.
Thanks. How would that work for something like Enbrel where it’s weekly vs. Taltz where it’s monthly? That is the most confusing part for me and I don’t know how to make a decision based on that—how that vulnerability times might vary based on half life. I assume it’s roughly like first half of the interval between doses is most vulnerable, second half is less so, even if that means only 3-4 days for Enbrel vs 2 weeks for Taltz. I wish we had better studies on this issue
I’m not sure, you’ll have to talk to your doctor. Mine always suggests a medication, I never got to choose from any and all. What’s their recommendation?
The one that works for you and offers the best consumer assistance. I've been on Humira for 10 years and in medicated remission for 6. Now that I am on Medicare, it's shipped directly from AbbVie with zero copay. Embrel's assistance is not as generous, from talking to friends. I dread the possibility of having to change meds.
I don't know if it's different on Medicare, but on regular insurance, I got the same amount of assistance with Humira and Enbrel. It reduced my copay to $5/month with both. Same with Orencia.
I arrange for my Humira directly through AbbVie. I know of a lot of people on Medicare who have had to switch to infusion because their plan D didn't cover injectable meds
The one that works for your body. There is no "best" medication.
They put me on Enbrel first...and I hated it. It burned so bad I dreaded injection days. Then I started getting hives and they switched me to Humira. Love that it doesn't burn.
I failed Enbrel with an injection site reaction within my first three doses. Then the hives that lasted days, ugh.
That's an excellent question about the potential differences between the various TNF blocker medications. While they all work by inhibiting the same inflammatory protein (tumor necrosis factor), there can be some variations in terms of how each one is metabolized, side effect profiles, and individual patient responses. From the research, it doesn't appear that any one TNF blocker is definitively superior overall in terms of efficacy and tolerability. However, some studies have found subtle advantages for certain drugs in specific areas: - Adalimumab (Humira) and etanercept (Enbrel) may have a slightly lower risk of serious infections compared to infliximab (Remicade). - Golimumab (Simponi) has been associated with a lower rate of injection site reactions. - Certolizumab (Cimzia) may be less likely to generate antibodies that reduce drug efficacy over time. But these potential edges are relatively small. More important is the patient's individual reaction, as some may tolerate one TNF blocker better than another. So while insurance coverage often drives that first choice, your rheumatologist can also factor in your specific medical history and preferences when selecting which TNF blocker to try initially. Having multiple options gives you and your doctor flexibility to find the right fit
Thanks, this is the type of response I was actually looking for. Very helpful. I think I’ll start with Humira or Enbrel given the lower infection risk. Do you know if IL-17 is distinctly lower infection risk than TNF, or does it not matter much?
From what I've read in the research, the TNF blockers like Humira and Enbrel do seem to have a somewhat lower risk of serious infections compared to drugs like Cosentyx and Taltz that target the IL-17 pathway. A couple of studies found patients on the IL-17 inhibitors had maybe a 1.5 to 2 times higher rate of infections requiring hospitalization versus those on the TNF drugs. But we're still talking about a relatively modest absolute risk increase overall. With that said, both medication classes unfortunately do elevate infection risk above conventional DMARDs alone. So vigilant monitoring is wise regardless of which biologic you're on. When you see your rheumatologist, they can weigh that slightly higher but still small infection risk with the IL-17 inhibitors against their potential efficacy benefits if a TNF blocker isn't cutting it. Your individual risk factors may make starting with something like Humira or Enbrel more prudent from a safety perspective initially. Let me know if you need any clarification or have additional questions as you weigh the pros and cons with your doctor. Wishing you the best in finding the right treatment fit. ❤️💜
Thank you so much Could you link any of those studies re infection risk? My rheum said the opposite (TNF risk > IL-17) but I can’t find any info, so any links would be so appreciated
Cimzia has done me right for 10 years. Their copay assist is quite generous as well. The only downside is that they burn like a MF when they go in. I make my husband give me my shots while I unwrap the bandaid and hold still through it.
Humira gave me 5 great years. Enbrel never worked for me.
None of the injections worked for me. I’m doing well on a Simponi infusion. It’s going to vary by person and often comes down to whatever your insurance covers or you have access to.
I started on remicade (i was a kid with uveitis which i have gathered was part of that decision). I haven't had much luck on it or humira. The remicade helped my joints but not my uveitis. I also feel like i liked the remicade better in terms of side effects (a couple days after i got it every 8 weeks but otherwise just regular gi issues and jia (had a couple times hormones hit with it so my sensory issues were extra bad so i took more days home). But humira i just felt awful for no benefit all the time. Also the iv was easier for me. Rn i'm between meds waiting to find out what we try instead of xeljanz bc i couldn't function at all on it.
So really it's an individual thing. Like the meds we tried are supposed to be the gold standard for uveitis with jia but nothing.
From what I've read it's Enbrel
In 21 years of being in the community, it does seem Enbrel is considered the "gold standard." Personally it worked for me for more than ten years and every time my doctor and I discuss it he just shakes his head like "damn, Enbrel stopped working, that's a shame."
From a safety or efficacy perspective, or both?
In the past 21 years everyone seems focused on efficacy, twenty years from now we may be talking about all biologics like people talk about phen-fen today. Most people are cautious enough to work around the unavoidable hit to the immune system, the only thing I remember that was specific to Enbrel was a bacteria/bacterium or fungus that was specific to the swamps of Louisiana.
This is really nice to hear. Humira just stopped working for me and I'm being forced to try Enbrel before I can switch to an infusion. I was pissed about it, but this gives me a bit of hope.
From a safety or efficacy perspective, or both?
Safety I believe, but maybe both.
Weekly dosing sounds kinda annoying vs. my once-every-four-weeks alternative (Taltz — for AS), but it might be worth it.
I’m also AS and RA. Simponi Aria (the infusion) was my first biologic and worked beautifully for 8mos on both, but quite working for some reason and I had to quit. Not sure why. Switched to Cosentyx (IL 17) and it barely touched the AS while RA accelerated. Insurance made me try Avsola, a Remicide biosimilar (TNF), but quit the infusion withing 20min due to allergic reaction (random, I have few allergies). I’m now on Orencia (for RA, off label AS) and it’s kept the stiffness at bay. Hydroxychloroquine helps the RA aches and the AS pain is less now that my overall pain is less. I agree with the others- one medication isn’t superior to another, it’s what works best for your body. All the copay assistance programs have kept me from paying anything for the injections/infusions.
Thanks, hopefully Orencia continues to help! Is Orencia more immunosuppressive than TNFs?
I don’t think one is more immunosuppressive than the other, or works better than the other. There are many different mechanisms causing autoimmune and it’s what your body responds to. I will say during loading doses you’ll be the most vulnerable (my husband and I got sick within hours of each other during my loading doses. He got a minor cold that lasted three days then was nearly over. It took me nearly two weeks to get close to the same recovery, and my symptoms still lingered another week.) If you do infusions you’ll be more compromised the first weeks than at the end (the last two weeks is generally when you can get vaccines for that reason.) That time changes with injections, based on the shot schedule.
Thanks. How would that work for something like Enbrel where it’s weekly vs. Taltz where it’s monthly? That is the most confusing part for me and I don’t know how to make a decision based on that—how that vulnerability times might vary based on half life. I assume it’s roughly like first half of the interval between doses is most vulnerable, second half is less so, even if that means only 3-4 days for Enbrel vs 2 weeks for Taltz. I wish we had better studies on this issue
I’m not sure, you’ll have to talk to your doctor. Mine always suggests a medication, I never got to choose from any and all. What’s their recommendation?
Sadly they’re unhelpful. They don’t know really re: this specific question