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What is the difference between Remicade,Humira, Symponi,Tysabri and other biologics?

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Ulcerative Colitis
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Posted 7/15/2014 5:50 PM (GMT 0)
Seems like it is time for me to move to biologics. So trying to get as much information as possible. How many different biologics out there and how do you decide which one to start with?

Also do you have to take 6mp/imuran with biologics?

Posted 7/15/2014 6:22 PM (GMT 0)
I would try entyvio before the other biologics. It has a much better safety record. It's very new and looks very promising so far.
Posted 7/15/2014 7:54 PM (GMT 0)
How to choose a biologic for uc? Well, the biggest factors are out-of-pocket cost to you, convenience, and foremost of which what your insurance company blesses you to take. You need to do your homework.

First, stay away from Tysabri it has a big black box warning about PML, a fatal brain disorder. It has been replaced by Entyvio, a newer medication which does not have that risk.

Remicade and Entyvio are mixed with IV fluid and given via an injection in the arm or hand under the supervision of a nurse (not a pill you get from your pharmacy like your other uc prescriptions). In some cases, if you use your insurance companies preferred script service (e.g., CVS Caremark, or Express scripts) there is a maximum out of pocket cost, such as $300 or $250 for each dose. Don't use their script service and they are often billed under hospital categories, subject to insurance deductibles before the insurance company pays and can be expensive with certain policies. Check your insurance policy, or give the company a call and ask how injectable/infusion medications are billed, and how much you will have to pay. Both drugs do have patient assistance programs which help take some of the sting out of it.

Simponi and Humira are given through subcutaneous (just beneath the skin) self-injections. These are something that you can do, after a nurse shows you how. It is a syringe with a small needle you use to administer. These are medications you can get from your pharmacy or have delivered to you. Certain insurance policies may bill these different than remicade, might be cheaper, check and see (policies differ). These medications have patient assistance programs.

Which medications have been around the longest? Remicade was the 1st biologic approved for uc, followed by Humira, Simponi, and very recently Entyvio. Remicade has the longest track record. Evidence seems to point it to be more effective for uc than Humira and Simponi are. Humira is the least effective for uc. Simponi is in between Remicade and Humira.

Entyvio is very new on the market, approved a month or so ago. It holds great promise, seems very safe, but it may be hard to get administered and approved by your insurance company at this time. Can't hurt to ask but you might have to try remicade or humira first. Entyvio has a patient assistance program.
Posted 7/15/2014 8:05 PM (GMT 0)
Also do you have to take 6mp/imuran with biologics? Yes, it is generally recommended. This is because your body can develop antibodies to remi, humira, and/or simponi over time without the use of 6mp/imuran. Those antibodies will either make those medications stop working entirely or be less effective. If your immune system is suppressed with 6mp/imuran than that is much less likely to occur.
Posted 7/15/2014 9:35 PM (GMT 0)
My GI told me the only difference between Remi and Humira was the way it was administered (otherwise they are basically the same med that work the same way--Remi made from a mouse protein and Humira made from a human protein) he explained they are both biologics and work the same, it's just that some people may respond better to one than the other for many different reasons. Tysabri wasn't offered to me so I know nothing about it (I'm in Canada)
Posted 7/16/2014 12:36 AM (GMT 0)
To answer your question from the more sciencey end of things: there are 2 main types of biologics for UC, TNF-alpha blockers and white blood cell trafficking blockers.

Remicade, Humira, and Simponi all work by blocking the affects of a molecule called TNF-alpha. TNF-alpha is a cytokine, which is a signalling molecule secreted by your body's immune cells. TNF-alpha is pro-inflammatory which means that the signals its responsible for help to induce inflammation. By binding to and blocking its signalling, we are able to reduce inflammation.

Entyvio and Tysabri fall under the category of "white blood cell trafficking" blockers (not the official name but I like to keep things simple). In order for white blood cells to get into GI tissue (from the blood), they need to bind to the cells in the walls of the blood vessels. These two drugs prevent the binding of white blood cells to these blood vessel walls and thus prevent the white blood cells from getting into GI tissue and causing the inflammation we see. Without getting bogged down in the details, Entyvio doesnt carry the risk of PML (the viral brain infection) seen in Tysabri because the protein that Entyvio binds too is only found in GI tissue, where as the protein that Tsyabri binds to is all found in central nervous system tissue.
Posted 7/16/2014 1:13 AM (GMT 0)
Hmmm, I wonder why I'm not responding as well as I should be by now with Humira...I started it February 12 of this year and it's been 5 months already and I'm still having issues with frequency and urgency...I take one 40 mg injection pen once every 2 weeks...I'll be getting another scope done August 19th so my GI can see if my RV fistula has healed up and how my inflammation looks.
Posted 7/16/2014 1:15 AM (GMT 0)
Not much, except for how long they have been around
Posted 7/16/2014 1:48 AM (GMT 0)

nightside of eden said...
Not much, except for how long they have been around

Thats not even a little bit true....
Posted 7/16/2014 2:28 AM (GMT 0)
pb4, I would up the Humira to weekly. I felt a big improvement after I increased the dose. Simponi is given every 4 weeks. Works better then Humira did. When that stops working onto entyvio .
Posted 7/16/2014 2:50 AM (GMT 0)

Marauder93 said...

nightside of eden said...
Not much, except for how long they have been around

Thats not even a little bit true....


Some are mouse proteins some are human proteins, all are TNF blockers.....so yes, they all do the same thing, some are just a little more effective for biologics in terms of patients where this is the last resort
Posted 7/16/2014 2:52 AM (GMT 0)

nightside of eden said...

Marauder93 said...

nightside of eden said...
Not much, except for how long they have been around

Thats not even a little bit true....


Some are mouse proteins some are human proteins, all are TNF blockers.....so yes, they all do the same thing, some are just a little more effective for biologics in terms of patients where this is the last resort

1) None are pure mouse proteins; Remicade is chimeric which means it has both human and mouse protein.

2) Only Remicade, Humira, and Simponi are TNF antibodies, the other 2 are not.
Posted 7/16/2014 2:53 AM (GMT 0)
Also, biologics are the new wave in killing your pocket......when many of them have less than a 40% remission rate
Posted 7/16/2014 1:46 PM (GMT 0)
Wow!!! I am sure none of doctor will be able to provide all this information. I know all carry some kind of risk but comparing all which one would be safer.

If you go with entyvio, do you have to 6mp with it?
Posted 7/16/2014 2:10 PM (GMT 0)

PamSmith said...
Wow!!! I am sure none of doctor will be able to provide all this information. I know all carry some kind of risk but comparing all which one would be safer.

If you go with entyvio, do you have to 6mp with it?

Based on the available data, Entyvio is the safest. We dont have long term data on it (as we do with the others), but there is no reason to expect anything crazy. If it were me, or I had to recommend it to a patient, I wouldnt hesitate to go with this one.

As for 6-mp, its actually not really necessary for Entyvio because it is a fully human antibody, which (without getting into the details) means that there is already a reduced risk of developing antibodies to it (which would prevent it from working). 6-mp will lower the risk more, but I think I remember reading that only about 4% of people develop antibodies to this drug
Posted 7/16/2014 2:18 PM (GMT 0)

PamSmith said...
Wow!!! I am sure none of doctor will be able to provide all this information. I know all carry some kind of risk but comparing all which one would be safer.

If you go with entyvio, do you have to 6mp with it?

All of the tnf-alpha blocking medications (remicade, humira, simponi) carry a statistically small risk of lymphoma (6 in 10,000 or 0.006%) but even the risk in those small odds are called into question by some scientific studies (may be no increased risk at all). These medications also make one more prone to getting infections (utis, bronchitis, etc) and it becoming serious if you do not seek treatment. You don't have to be a gemaphobe or anything, but the increased risk is there. Pretty much see your family dr sooner if you suspect you might have one.

Entyvio doesn't carry the above described risks as it only targets gut-specific tissue. All of the other meds are systematic and can cause symptoms anywhere within your body. In theory Entyvio is a lot safer, but it has no history like the others. Often, side effects are added after a medication has been on the market for a while. There is some risk choosing a medication that has only been approved for uc for a month.
Posted 7/16/2014 3:54 PM (GMT 0)
Thanks Faith, I sorta figured that my GI would likely suggest the same thing, he just wants to scope me first...thanks for responding!
Posted 8/2/2014 3:03 PM (GMT 0)
I was approved for Entyvio, but that approval was rescinded. It seems one must have tried a biologic to get insurance approval for Entyvio. I was excited to try it, since I have had bad allergic reactions to Asacol and Imuran and Colazal put me in the hospital for a week.

My UC symptoms were quiet for a year, but then I developed arthritic conditions in my hands and neck. My gut issues were more or less fine.

The insurance company would not approve Entyvio until I tried Remicade. I refused Remicade, and my doctor argued that since it has similarities to meds which i was allergic to, that Humira might be a better choice.

I'm annoyed and frustrated that they will not let me try the Enyvio (which, while new, shows far fewer side effects) and want me to first try something which has had some nasty side effects. I understand that some people have had success with Humira, and I may be one of them, but the prospect of undergoing treatment that could have a detrimental effect is not terrific.
Posted 8/2/2014 3:56 PM (GMT 0)
Yeah. That sucks. It all boils down to money really. Entyvio I'm sure costs more than Humira so they like you to go up the cost ladder. It's not really the med ladder. The side effects are of no consequence, if they can treat you with the cheaper Humira they want you to try that first. A doctor should be able to prescribe what he thinks is in the patient's best interest without having to wonder about an insurance company's requirements. I just talked to my GI about this on my last visit. He thinks it sucks that he has to prescribe something to someone when he would really rather prescribe something else, just due to insurance hoops.
Posted 8/2/2014 5:20 PM (GMT 0)
Entyvio will probably not be approved until you try and fail another biologic like Remicade.

I've been on Entyvio for 5 weeks now, got my 3rd infusion next week. My doctor is undecided about weather I should be on 6mp with it or not....there is a very small chance of developing antibodies to it (like 4% compared to 40% with Remicade - something like that)...but right now I'm NOT on 6mp anymore.

The receptors it binds to are found primarily in the GI tissue but there are also some in the chest, so you are more prone to respiratory infections while on it. But it's not as systemic as the other Biologics as everybody else mentioned so it is supposedly much safer.

My doctor has 8 people on Entyvio right now - they want to put more people on it but he told me the insurance companies haven't even told them how much they would reimburse them for it so they're hesitant to put more patients on it until that all gets worked out. I STILL don't know how much out of pocket it's going to cost me.

Post Edited (UCHater) : 8/2/2014 11:27:01 AM (GMT-6)

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