{"id":55056,"date":"2022-11-03T13:47:36","date_gmt":"2022-11-03T17:47:36","guid":{"rendered":"https:\/\/www.singlecare.com\/blog\/?p=55056"},"modified":"2024-10-25T11:04:18","modified_gmt":"2024-10-25T15:04:18","slug":"enbrel-alternatives","status":"publish","type":"post","link":"https:\/\/www.singlecare.com\/blog\/enbrel-alternatives\/","title":{"rendered":"Enbrel alternatives: What can I take instead of Enbrel?"},"content":{"rendered":"

Those with <\/span>autoimmune diseases<\/span>, such as <\/span>rheumatoid arthritis<\/span><\/a> (RA), <\/span>Crohn’s Disease<\/span><\/a>, <\/span>ulcerative colitis<\/span><\/a>, and <\/span>plaque psoriasis<\/span><\/a> not only suffer the symptoms of their diagnosis but often multiple trials of <\/span>prescription drugs<\/span> until they settle upon one (or a combination) that best fits their lifestyle and manages their symptoms. <\/span>Enbrel<\/span><\/a> (<\/span>etanercept<\/span>) is a member of a <\/span>biologic drug<\/span> class known as <\/span>Tumor Necrosis Factor<\/span> (<\/span>TNF<\/span>) <\/span>inhibitors<\/span> used to <\/span>treat rheumatoid arthritis<\/span> and other <\/span>autoimmune conditions<\/span> like <\/span>polyarticular juvenile idiopathic arthritis<\/span>, <\/span>ankylosing spondylitis<\/span>, or <\/span>psoriatic arthritis<\/span>. <\/span><\/p>\n

TNF<\/span> inhibitors<\/span> are initiated after failure or contraindication to first-line, conventional <\/span>disease-modifying anti-rheumatic drugs<\/span> (<\/span>DMARDs<\/span>). <\/span>TNF<\/span> inhibitors<\/span> make up 90% of patients’ first <\/span>biologic<\/span> treatment. Selecting a <\/span>TNF<\/span> inhibitor<\/span> may be influenced by price or <\/span>health insurance<\/span> copay<\/span>, route of administration and patient’s comfort level, dosing frequency, other concomitant conditions, and adverse effects. <\/span>Enbrel<\/span> can be self-administered and is dosed once weekly, and while a <\/span>common side effect<\/span> includes <\/span>injection-site reactions<\/span>, this option may be desirable over infusions that must be administered in a <\/span>healthcare<\/span> setting. <\/span><\/p>\n

For patients on <\/span>immunosuppressants<\/span> and at high risk of <\/span>serious infections<\/span>, <\/span>Enbrel<\/span> may be preferable to other <\/span>TNF<\/span> inhibitors<\/span> because it causes lower infection rates than alternatives in its class. On the flip side, <\/span>Enbrel<\/span> isn’t the ideal choice for the management of RA in the setting of concomitant inflammatory bowel disease or inflammatory eye disease because it is known to be inferior to other members in the <\/span>TNF<\/span> inhibitor<\/span> class for these conditions. Additionally, <\/span>TNF<\/span> inhibitors<\/span> are just one subset of <\/span>DMARDs<\/span>. Here we will discuss <\/span>Enbrel<\/span> and its alternatives in the management of RA. <\/span><\/p>\n

What can I take in place of <\/span>Enbrel<\/span>?<\/span><\/h2>\n

The <\/span>American College of Rheumatology (ACR) <\/span><\/a>recommends a treat-to-target approach for patients with RA, meaning that patients should begin treatment as soon as RA is diagnosed to slow irreversible <\/span>joint damage<\/span>. Oral <\/span>methotrexate<\/span> remains the first-line treatment unless a patient can’t tolerate it or has a contraindication to it and is considered a conventional synthetic <\/span>DMARD<\/span> (csDMARD) that was developed without a specific target within the <\/span>immune system<\/span>. Targeted synthetic <\/span>DMARDs<\/span> (tsDMARDs) contrast with <\/span>methotrexate<\/span> since they specifically target proinflammatory molecules. <\/span>Biologic<\/span> DMARDs<\/span> (bDMARDs) are large molecules and highly specific to certain immune pathways. Drug classes within the bDMARD umbrella category include <\/span>TNF<\/span> inhibitors<\/span> like <\/span>Enbrel<\/span>, CD80\/86 costimulatory modulators, IL-6 <\/span>inhibitors<\/span>, CD20 <\/span>inhibitors<\/span>, and within tsDMARDs are the JAK <\/span>inhibitors<\/span>. After <\/span>methotrexate<\/span> and other csDMARDs, alternative available options within bDMARDs may be more suitable than <\/span>Enbrel<\/span> for certain individuals due to <\/span>cost<\/span><\/a>, <\/span>side effects<\/span>, and concomitant conditions.<\/span><\/p>\n

RELATED: Does Medicare cover Enbrel?<\/a><\/strong><\/p>\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n
\n

Compare Enbrel alternatives<\/span><\/h2>\n<\/th>\n<\/tr>\n<\/thead>\n

Drug name<\/b><\/td>\nUses<\/b><\/td>\nDosage<\/b><\/td>\nSavings options<\/b><\/td>\n<\/tr>\n
Enbrel<\/span> <\/span><\/p>\n

(<\/span>etanercept<\/span>) <\/span><\/td>\n

Ankylosing spondylitis<\/span>, graft-versus-host disease, <\/span>plaque psoriasis<\/span>, <\/span>psoriatic arthritis<\/span>, RA <\/span><\/td>\n50 mg SubQ once weekly<\/span><\/td>\nEnbrel<\/span> coupons<\/span><\/a> <\/span><\/td>\n<\/tr>\n
Otrexup (<\/span>methotrexate<\/span>) <\/span><\/td>\nRA, <\/span>Crohn’s Disease<\/span>, <\/span>Psoriasis<\/span>, systemic lupus erythematosus, giant cell arteritis<\/span><\/td>\nInitiate and titrate to 15 mg once weekly with 4 to 6 weeks; increase as tolerated up to a maximum of 25 mg once weekly<\/span><\/td>\nOtrexup coupons<\/span><\/a> <\/span><\/td>\n<\/tr>\n
Orencia<\/span> Clickject (abatacept) <\/span><\/td>\nGraft-versus-host disease prophylaxis, <\/span>psoriatic arthritis<\/span>, RA<\/span><\/td>\nSubQ: 125 mg one weekly<\/span><\/p>\n

IV: <\/span><\/p>\n

    \n
  • Less than 60 kg: 500 mg every 4 weeks<\/span><\/li>\n
  • 60-100 kg: 750 mg every 4 weeks<\/span><\/li>\n
  • Greater than 100 kg: 1000 mg every 4 weeks<\/span><\/li>\n<\/ul>\n<\/td>\n
Orencia<\/span> Clickject coupons<\/span><\/a> <\/span><\/td>\n<\/tr>\n
Actemra Actpen (tocilizumab) <\/span><\/td>\nCOVID-19, Cytokine release syndrome, Giant cell arteritis, RA, scleroderma-associated interstitial lung disease<\/span><\/td>\nSubQ <\/span><\/p>\n
    \n
  • Less than 100 kg: 162 mg every 1 to 2 weeks <\/span><\/li>\n
  • Greater than or equal to 100 kg: 162 mg every week<\/span><\/li>\n<\/ul>\n

    IV:<\/span><\/p>\n

      \n
    • 4-8 mg\/kg (max 800 mg) every 4 weeks<\/span><\/li>\n<\/ul>\n<\/td>\n
Actemra Actpen coupons<\/span><\/a><\/td>\n<\/tr>\n
Rituxan <\/span><\/p>\n

(rituximab) <\/span><\/td>\n

B-cell acute lymphoblastic leukemia, Burkitt <\/span>lymphoma<\/span>, chronic lymphocytic leukemia, dermatomyositis, graft-versus-host disease, Hodgkin <\/span>lymphoma<\/span>, lupus nephritis, multiple sclerosis, Non-Hodgkin <\/span>lymphoma<\/span>, RA<\/span><\/td>\n1000 mg IV every 2 weeks x 2 doses; repeat after 6 months<\/span><\/td>\nRituxan coupons<\/span><\/a> <\/span><\/td>\n<\/tr>\n
Xeljanz <\/span><\/p>\n

(tofacitinib) <\/span><\/td>\n

Ankylosing spondylitis<\/span>, COVID-19, <\/span>psoriasis<\/span>, <\/span>psoriatic arthritis<\/span>, RA, <\/span>ulcerative colitis<\/span><\/td>\nImmediate release: 5 mg orally twice daily<\/span><\/p>\n

Extended release: 11 mg orally once daily<\/span><\/td>\n

Xeljanz coupons<\/span><\/a> <\/span><\/td>\n<\/tr>\n
Arava <\/span><\/p>\n

(leflunomide) <\/span><\/td>\n

BK virus, Cytomegalovirus disease, RA<\/span><\/td>\nLoading dose: 100 mg once<\/span><\/p>\n

Maintenance dose: 20 mg once daily; may reduce to 10 mg once daily if cannot tolerate adverse effects<\/span><\/td>\n

Arava coupons<\/span><\/a> <\/span><\/td>\n<\/tr>\n
Plaquenil (hydroxychloroquine) <\/span><\/td>\nDermatomyositis, lupus erythematosus, malaria, Q fever, RA, sarcoidosis<\/span><\/td>\n200 mg to 400 mg once daily<\/span><\/td>\nPlaquenil coupons<\/span><\/a> <\/span><\/td>\n<\/tr>\n
Azulfidine (sulfasalazine) <\/span><\/td>\nAnkylosing spondylitis<\/span>, <\/span>Crohn’s disease<\/span>, <\/span>psoriatic arthritis<\/span>, RA, <\/span>ulcerative colitis<\/span><\/td>\n500 mg once or twice daily; can increase up to 3 g per day (split into two doses)<\/span><\/td>\nAzulfidine coupons<\/span><\/a> <\/span><\/td>\n<\/tr>\n
Remicade<\/span> <\/span><\/p>\n

(<\/span>infliximab<\/span>) <\/span><\/td>\n

Ankylosing spondylitis<\/span>, <\/span>Crohn’s disease<\/span>, <\/span>plaque psoriasis<\/span>, <\/span>psoriatic arthritis<\/span>, pustular <\/span>psoriasis<\/span>, RA, sarcoidosis, <\/span>ulcerative colitis<\/span><\/td>\n3 to 10 mg\/kg intravenous every 4 to 8 weeks<\/span><\/td>\nRemicade<\/span> coupons<\/span><\/a> <\/span><\/td>\n<\/tr>\n
Humira<\/span> <\/span><\/p>\n

(<\/span>adalimumab<\/span>) <\/span><\/td>\n

Axial spondyloarthritis, <\/span>Crohn’s disease<\/span>, hidradenitis suppurativa, <\/span>plaque psoriasis<\/span>, <\/span>psoriatic arthritis<\/span>, RA, sarcoidosis, <\/span>ulcerative colitis<\/span>, uveitis<\/span><\/td>\n40 mg SubQ every 2 weeks <\/span><\/td>\nHumira<\/span> coupons<\/span><\/a><\/td>\n<\/tr>\n
Simponi<\/span> <\/span><\/p>\n

(golimumab) <\/span><\/td>\n

Ankylosing spondylitis<\/span>, <\/span>psoriatic arthritis<\/span>, RA, <\/span>ulcerative colitis<\/span>, axial spondyloarthritis <\/span><\/td>\nSubQ: 50 mg every month<\/span><\/p>\n

IV: 2 mg\/kg IV every 8 weeks<\/span><\/td>\n

Simponi<\/span> coupons<\/span><\/a> <\/span><\/td>\n<\/tr>\n
Cimzia<\/span> <\/span><\/p>\n

(<\/span>certolizumab<\/span>) <\/span><\/td>\n

Ankylosing spondylitis<\/span>, axial spondyloarthritis, <\/span>Crohn’s disease<\/span>, <\/span>plaque psoriasis<\/span>, <\/span>psoriatic arthritis<\/span>, RA<\/span><\/td>\n200 mg SubQ every 2 weeks<\/span><\/td>\nCimzia<\/span> coupons<\/span><\/a> <\/span><\/td>\n<\/tr>\n
Kevzara <\/span><\/p>\n

(sarilumab) <\/span><\/td>\n

COVID-19, RA<\/span><\/td>\n200 mg SubQ every 2 weeks<\/span><\/td>\nKevzara coupons<\/span><\/a> <\/span><\/td>\n<\/tr>\n
Olumiant <\/span><\/p>\n

(baricitinib) <\/span><\/td>\n

Alopecia, COVID-19, RA<\/span><\/td>\n2 mg orally once daily<\/span><\/td>\nOlumiant coupons<\/span><\/a> <\/span><\/td>\n<\/tr>\n
Rinvoq <\/span><\/p>\n

(upadacitinib) <\/span><\/td>\n

Ankylosing spondylitis<\/span>, atopic dermatitis, <\/span>psoriatic arthritis<\/span>, RA, <\/span>ulcerative colitis<\/span><\/td>\n15 mg orally once daily<\/span><\/td>\nRinvoq coupons<\/span><\/a> <\/span><\/td>\n<\/tr>\n
Kineret<\/span> <\/span><\/p>\n

(anakinra)<\/span><\/td>\n

Gout, pericarditis, RA<\/span><\/td>\n100 mg SubQ once daily <\/span><\/td>\nKineret<\/span> coupons<\/span><\/a> <\/span><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

Top 5 <\/span>Enbrel<\/span> alternatives<\/span><\/h2>\n

The following are some of the most common alternatives to <\/span>Enbrel<\/span>.<\/span><\/p>\n

1.  Otrexup (methotrexate)<\/h3>\n

Methotrexate<\/span><\/a> remains the first line therapy in the management of RA unless a patient has a specific reason they shouldn’t receive it. Contraindications for <\/span>methotrexate<\/span> include pregnancy, chronic kidney disease, and liver disease. <\/span>Methotrexate<\/span> is recommended over other tsDMARDs and bDMARDs due to its extensive data on safety, efficacy, low cost, and flexibility in administration-it is available as tablets and a self-injectable <\/span>subcutaneous<\/span> formulation. <\/span>Methotrexate<\/span> is also convenient since the most common <\/span>dose<\/span><\/a> for RA is 15 mg once weekly, which is the goal dose to achieve within four to six weeks of initiation of therapy. <\/span><\/p>\n

Methotrexate<\/span> does come with many <\/span>side effects<\/span><\/a>, including GI effects like diarrhea, nausea, oral ulcers, and vomiting. It is recommended to take <\/span>methotrexate<\/span> with folic acid which may reduce some of these effects. If patients continue to experience significant <\/span>side effects<\/span>, the dose can be split and taken as two separate doses on the same day or the <\/span>subcutaneous<\/span> formulation may offer some relief. <\/span>Methotrexate<\/span> also comes with the potential for quite a few serious <\/span>drug interactions<\/span> and cannot be taken with a wide range of both prescription and over-the-counter medication or <\/span>supplements<\/span>. <\/span>Methotrexate<\/span> should never be given in conjunction with live <\/span>vaccines<\/span>, for example. <\/span><\/p>\n

Always seek <\/span>medical advice<\/span> when starting new medications or <\/span>supplements<\/span> while on <\/span>methotrexate<\/span>. Patients may be apprehensive to read about <\/span>methotrexate<\/span> since it is considered an oral chemotherapy, but the doses used to treat RA are significantly lower than the doses used for the management of different types of cancer. <\/span><\/p>\n

2. Orencia (abatacepte)<\/h3>\n

Orencia<\/span> is considered a selective T-cell costimulatory modulator and binds to receptors CD80 and CD86 on cells known as antigen-presenting cells. This prevents T-cell proliferation and B-cell stimulation-a phenomenon which contributes to joint inflammation experienced in RA. While initially approved for intravenous infusion in patients who do not respond or could not tolerate\/take <\/span>methotrexate<\/span> and <\/span>TNF<\/span> inhibitors<\/span>, it is now <\/span>FDA approved<\/span> for use as a self-injectable <\/span>subcutaneous<\/span> formulation providing patients with greater autonomy for its use. The intravenous formulation only needs to be administered every four weeks, whereas the <\/span>subcutaneous<\/span> (self-injectable) must be administered weekly. Patients with <\/span>chronic obstructive pulmonary disorder (COPD) <\/span><\/a>may experience <\/span>worsening<\/span> of symptoms while receiving this therapy and may not be ideal candidates for this therapy. <\/span><\/p>\n

3. Actemra (tocilizumab)<\/h3>\n

Actemra is in an additional class of bDMARDs for the treatment of RA known as IL-6 receptor <\/span>inhibitors<\/span>. IL-6 concentrations are known to be elevated in RA, which in turn is associated with immune activation. Actemra is administered either by intravenous infusion or is available as a <\/span>prefilled syringe<\/span> and is able to be self-injected <\/span>subcutaneously<\/span>. Like all bDMARDs, Actemra use will also come with a range of possible <\/span>side effects<\/span>, the most serious being increasing the <\/span>risk of infection<\/span> and <\/span>increased risk of GI perforation<\/span><\/a>. Given the prior, patients must be ruled out for certain <\/span>respiratory infections<\/span> prior to use, like tuberculosis, and <\/span>hepatitis B<\/span>. Given the latter, Actemra should be avoided in patients with a known underlying indication that may additively contribute to this risk, such as a history of diverticulitis. Patients taking this medication will require frequent monitoring of white <\/span>blood cells<\/span> and platelets, as well as labs to indicate any level of liver damage or hyperlipidemia. <\/span><\/p>\n

4. Rituxan (rituximab)<\/h3>\n

Rituxan is an anti-CD20 monoclonal <\/span>antibody<\/span> with several indications in addition to treatment refractory RA nonresponsive to other <\/span>DMARDs<\/span>. It shouldn’t be an initial bDMARD, whereas a <\/span>TNF<\/span> inhibitor<\/span> like <\/span>Enbrel<\/span> is. However, if a patient goes through several lines of therapy without achieving remission, this option has a good chance of success. The benefit of this medication over many others includes its relatively infrequent dosing-most patients receive two doses every six months. Rituxan is only available as an IV infusion in comparison to several other alternatives which offer a self-injectable route of administration, and <\/span>even the infusion itself <\/span><\/a>comes with warnings and precautions for causing reactions. Rituxan, given its profound effect on the <\/span>immune system<\/span>, greatly increases the <\/span>risk of infections<\/span>-it minimizes a person’s ability to mount an immune response to <\/span>vaccines<\/span>, contributing to its place in therapy as more of a last-line agent. <\/span><\/p>\n

5. Xeljanz (tofacitinib)<\/h3>\n

Xeljanz<\/span><\/a> is a type of tsDMARD and is a member of one of the newest classes of agents used to treat RA known as JAK <\/span>inhibitors<\/span>. Xeljanz is different from many of the available treatment options for RA in that it is a tablet and has a much more targeted mechanism of action than cDMARDs. Unfortunately, Xeljanz does also come with safety concerns when used, including major adverse events like increased risk of heart attack stroke, blood clots, certain viral infections, malignancies like <\/span>lymphoma<\/span>, and even death. The incidence of overall infections with tsDMARDs is similar to those seen with bDMARDs, but another benefit of this class of drugs is a slightly lower incidence of severe infections. Screening for tuberculosis is still required prior to initiation of therapy, and herpes zoster <\/span>vaccination<\/span> is highly recommended because of an <\/span>increased risk of reactivation <\/span><\/a>on therapy in comparison to bDMARDs. All these risks combined must be weighed against its pros as a tablet and targeted mechanism in comparison to <\/span>biologics<\/span> like <\/span>Enbrel<\/span> after lack of remission on first-line therapies. <\/span><\/p>\n

Natural alternatives to <\/span>Enbrel<\/span><\/h2>\n

Lifestyle modifications like <\/span>exercise<\/span><\/a> are critical in people affected by RA to decrease fatigue and pain of RA. Other more natural approaches to the management of RA might include the addition of <\/span>probiotics<\/span><\/a>, which have some benefits in inflammatory conditions by providing a healthy balance of “good bacteria” in your gut. A well-balanced diet may be important for similar reasons. <\/span>Arnica<\/span><\/a>, which is a plant that has been used to manage pain and inflammation, may provide some symptom relief when applied in topical formulations to aching joints. Any alternative approaches to the management of RA should always be made under the <\/span>medical advice<\/span> of a <\/span>healthcare professional<\/span>. <\/span><\/p>\n

How to switch to an <\/span>Enbrel<\/span> alternative<\/span><\/h2>\n

Conventional synthetic <\/span>DMARDs<\/span>, like <\/span>methotrexate<\/span>, are first-line in the management of RA. Failure to achieve remission after a trial of these medications, or absolute contraindications to receive them, would give a <\/span>rheumatologist<\/span> the go-ahead to move down the <\/span>prescription drug<\/span> list to trial either a bDMARD or tsDMARD. <\/span>Studies<\/span><\/a> have demonstrated that reduced doses in combination with <\/span>methotrexate<\/span> may prolong low disease severity, and <\/span>others<\/span><\/a> have introduced the possibility of trialing off all medications with sustained remission. No therapy should be discontinued without the advice of a <\/span>healthcare professional<\/span>, as discontinuation may result in an increase in symptoms and a return to a higher level of disease severity.<\/span><\/p>\n

Biosimilars<\/span> are also a consideration when taking <\/span>biologic<\/span> agents like <\/span>brand-name<\/span> Enbrel<\/span>. While guidelines consider <\/span>biosimilars<\/span> equivalent to their <\/span>FDA-approved<\/span> counterparts, there are currently no recommendations on changing patients currently taking bDMARDS to an equivalent <\/span>biosimilar<\/span>. The most cost-effective option is ideal, but <\/span>health insurance<\/span> mandated changes to <\/span>biosimilars<\/span> pose potential concerns. Patients and <\/span>healthcare providers<\/span> should always be made aware before any automated changes in therapy occur. <\/span><\/p>\n

The COVID-19 pandemic highlighted some issues with <\/span>biologic<\/span> DMARDs<\/span> when shortages arose as it related to the management of RA and other autoimmune disorders. Actemra was granted <\/span>emergency use authorization (EUA) <\/span><\/a>by the <\/span>FDA<\/span> to treat hospitalized patients in response to the Delta variant, resulting in a global shortage of the <\/span>biologic<\/span>. This forced patients to face an inability to remain in adherence to their regimens, so the ACR has made recommendations to change within drug classes if necessary (versus changing to a <\/span>biologic drug<\/span> in a different class). <\/span><\/p>\n","protected":false},"excerpt":{"rendered":"

Those with autoimmune diseases, such as rheumatoid arthritis (RA), Crohn’s Disease, ulcerative colitis, and plaque psoriasis not only suffer the symptoms of their diagnosis but often multiple trials of prescription drugs until they settle upon one (or a combination) that best fits their lifestyle and manages their symptoms. Enbrel (etanercept) is a member of a […]<\/p>\n","protected":false},"author":133,"featured_media":55065,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[4589],"tags":[12164,790,4350],"coauthors":[10869],"class_list":["post-55056","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-drug-info","tag-arthritis","tag-chronic-disease","tag-prescription-savings","wpautop"],"acf":[],"yoast_head":"\nTop Enbrel alternatives and how to switch your Rx | SingleCare<\/title>\n<meta name=\"description\" content=\"Otrexup, Orencia, Actemra, Rituxan, and Xeljanz are some Enbrel alternatives. 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