Leuprolide: Eligard VS Lupron (1 mont... - Advanced Prostate...

Advanced Prostate Cancer
10,317 members12,221 posts

Leuprolide: Eligard VS Lupron (1 month, 3 month, 6 months)

cesanon
cesanon

I just discovered that Eligard is superior to Lupron in one respect.

It is injected into fatty tissue as opposed to muscle and as a result maintains more stable levels of leuprolide acetate than do Lupron injections.

The one disadvantage is that it appears almost no insurance covers Eligard.

My question is of Lupron 1 month, 3 month, or 6 month injections how does the relative stability of their Leuprolide levels compare? And how do they compare with that of Eligard?

Does anyone have any knowledge, ideas or even inklings?

==============

Also:

What about Firmagon (degarelix). I understand that it is an antagonist whereas Eligard and Lupron are agonists? Is that so? That doesn't sound so right to me?

49 Replies
oldestnewest

I have Medicare and a BCBS Florida Part D supplement and I didn’t pay anything for Eligard.

Don't know why insurance wouldn't pay. Eligard is quite a bit cheaper and works as well. That's why the VA uses it exclusively.

cesanon
cesanon
in reply to gregg57

According to Goodrx it appears that

Elegard is $1,283.47 (1 kit of Eligard 22.5mg)

Lupron is $564.78 (1 kit (2.8ml vial) of leuprolide 1mg/0.2ml)

In researching my Medicare Part D, it seems like none of the options I am looking include it in their formularies. And I am attempting to stick with the better plans, not the cheap ones.

timotur
timotur
in reply to cesanon

Isn't Lupron covered under part B?

dbrooks_h
dbrooks_h
in reply to timotur

Yes

Jimhoy
Jimhoy
in reply to cesanon

I can’t recall why, where I saw it but I remember seeing a pre approval from BC/BS for a 3mo Eligard 22.5 @ $4500.00!!!

And delivery is an absolute nothing!!

Jc

dbrooks_h
dbrooks_h
in reply to cesanon

Part d is for subscription drugs.

Look at your supplemental plan.

cesanon
cesanon
in reply to dbrooks_h

It is covered under my part D. Presumably for self injection.

dbrooks_h
dbrooks_h
in reply to cesanon

I get an injection every six months at the Hosiptal infusion center. It is covered under part b, 100 percent covered by medicare care and supplemental part F. Part D drugs are under the doughnut hole rule, that an added 5k expense.

I would not consider any of the mentions. The Vantas Implant is my go to Lutenizing agent delivery system. No injections---good for a minimum 15 months, and what is not talked about, is to use a drug/system that treats the cancer cells gently, while killing them softly.

I know no-one will understand the killing them softly approach. But we do not want to have angry aggressive Pca cells left when undetectable PSA's are reached.

Nalakrats

cesanon
cesanon
in reply to Nalakrats

Is the Vantas Implant the same active ingredient as in Lupron?

cesanon
cesanon
in reply to Nalakrats

Ohh it appears to be a different drug:

en.wikipedia.org/wiki/Histr...

"Histrelin is also available in a 12-month subcutaneous implant (Vantas) for the palliative treatment of advanced prostate cancer, since 2005 in the US, and since Jan 2010 in the UK."

It has been around a while. Other than convenience, what are the pros and cons of Vanta vis a vis Lupron?

Nalakrats
Nalakrats
in reply to cesanon

Well you got your info on the drug name---the advantages are many

1] One time treatment--that lasts 15 months.

2] Puts out a known daily dose--no loading up with 3 or 6 months worth of drugs

3] We call it Steady Eddie--no highs or lows from initial Injections, until you need the next one

4] Very reduced side effects compared to other Lutenizing agents. This was proved by one of our members, who found a study, about the reduced side effects--this was a comparative study.

5] When you want to go on vacation you just take the implant out---minor in Doctors office procedure.

6] All other Lutenizing agents when stopping takes 6 months for them to leave the body and for Testosterone to come back. Vantas, when out, in 30 days your T starts back, indicating it is out of your system. Last vacation--30 days T went to 230, 2 months 380, by month 4 I hit 550, and at month 6, I was over 700---all others would be close to zero at 6 months

7] Treated by Medicare as a clinical procedure. With my supplemental---cost is Zero.

8] At 76 I get some warm glows some nights for about 10 minutes, we all with low T sometimes need occasional naps, no difference, lose a word once in awhile, but I play Tournament Bridge--so I think my brain is fine. I was on vacation in 2018, on Implant until next week, when I go on vacation for 2020.

Nalakrats

cesanon
cesanon
in reply to Nalakrats

Any reason to speculate that it might be less effective than leuprolide acetate (Eligard or Lupron).

Nalakrats
Nalakrats
in reply to cesanon

Effectiveness is based on your T numbers. Last week my T was <10---so the efficiency is evident. Next week it is coming out.

Nalakrats

SuppWife
SuppWife
in reply to Nalakrats

Nal, could you post more about killing gently vs killing aggressively? Or direct me to literature/research?

If PSA is still low but increasing quickly would is restarting ADT with Vantas implant reasonable or would an initial shot of degarilex then switching to Vantas be a good plan? (We are of course discussing this with his MO but I appreciate opinions from people on this board who I know give these issues lots of thought and study and also bring their own experience) Husband’s been on a break from ADT at MO’s suggestion since April and PSA stayed “undetectable” (nadir 0.01) for 7 months until his T reached 610 (T low was ~10) and is now 0.52 increasing quickly (from 0.41 to 0.52 in 17 days.) MO wants to do Axumin scan when PSA gets a little higher and possibly spot treat any mets (none previously identified) but I’m afraid to wait to restart ADT with that velocity. So far ADT following RP is his only treatment. His T went from <10 to 476 in 5 months. When T was 476 PSA was 0.071 from 0.014 in June.

(And is Axumin the best scan to do ??)

I am only looking for perspectives, learned opinions, experiences and we will discuss with his MO.

His PSA was very high (17 and rising) after RP (34 at surgery) and I wish we would have demanded scans before ADT was started last year at that time, and it’s disappointing to me the doctor didn’t order them, but he was anxious to start ADT because the PSA was rising quickly. After everything I’ve learned since then I would have demanded it.

That’s why I appreciate hearing alternate opinions from people on this board.

Thank you

Nalakrats
Nalakrats
in reply to SuppWife

I never did answer the main question here---sorry--with the fast rising PSA--I would go for the shot--a monthly and do it again monthly, if necessary, and if PSA gets down near 1, better than 1 would be near 0.10 then I would consider the Vantas.

Sorry there were so many e-mails about not seeing responses to posts on a thread, that I lost you here.

By the way was this ever cleared up--as I do not understand what we have to do to see the responses in threads where one participated.

Nal.

P.S. My Implant went in 4 years ago at a PSA of 7.4 and in 75 days reached undetectable.

I also used Casodex with it.

cesanon
cesanon
in reply to Nalakrats

Putting aside Vanta and Eligard for the moment....

What is your opinion on: 1 month Lupron vs 3 month Lupron vs 6 month Lupron.?

And your reasoning?

Nalakrats
Nalakrats
in reply to cesanon

Sorry--I am way behind in catching up. I prefer the 1 month shot. You have less load in the system than a 3 or 6 month shot. If going on a vacation, your T will not recover for 6 months after the last Eligard is inserted wears out. So a one month shot on Jan.2nd, it will take till June to rid the side effects, and have the T come back. Longer lasting inserts of Eligard you can count accordingly. The Vantas--since it only puts out a daily dose, recovery starts in 30 days. My Vantas gets pulled this Thursday, to vacation a year. Be pumping serious iron by mid January.

Nalakrats

SuppWife
SuppWife
in reply to Nalakrats

Thank you for your response, Nal. My husband’s PSA right now is 0.52 and his MO suggests waiting till his PSA is a little higher to do scans before restarting ADT. I think we will test PSA again in two weeks to see how fast it’s moving. He had a great response with Firmagon last year.

Nalakrats
Nalakrats
in reply to SuppWife

In 2 weeks--to 4--Axumin Scans should show up the area/s--about 75% of the time.

Nalakrats

Victorq1
Victorq1
in reply to Nalakrats

Hi Nal

I asked if Vantas Implant is

available in Canada

and was told IT IS NOT ,with the B.C . Insurance ,which covers me.

Info:

pmprb-cepmb.gc.ca/view.asp?...

also it has been apparently discontinued in Britain (UK):

netdoctor.co.uk/medicines/c...

and

the third (world) country, I occasionally reside,

Vantas implant is not known and not sold.

It looks like a good idea and product

and you are lucky ,if it works for you

and others.

Nalakrats
Nalakrats
in reply to Victorq1

Is available all the time in the USA---I understand there are other manufacturers of similar products. Let me take a look.

Nalakrats

Nal, you mean that it kills the cancer cells continuously instead releasing large Lupron bombs once a week or so? I tried voice dictation earlier while in the sun and couldn't see the words that ended up on the page.

I do not understand what you are trying to say--your English got me lost.

Nalakrats

cesanon
cesanon
in reply to GeorgeGlass

I think you are reading what he said too literally. He was speaking more poetically than clinically.... I think

GeorgeGlass
GeorgeGlass
in reply to cesanon

kind of like shooting them continuously with a rifle instead of letting them accumulate and then dropping a 5k lb bomb on them once a week

Robert Frost I'm not lol

The Lutenizing agent is released on a daily basis--the amount needed for that day. I guess that's why without insurance it would be about 6,000 dollars.

Nalakrats

Do you think the adt will keep psa suppressed for a longer. Of time if it's released on a daily basis as opposed to just getting the shots of lupron?

I do not know---it is preferred by my Uro and 2 MO's--must be something we do in North Carolina.

Nalakrats

cesanon
cesanon
in reply to GeorgeGlass

The lupron shots, to my undertanding, slowly release the active ingredient over the prescribed period of time.

Etoile3
Etoile3
in reply to Nalakrats

What is Vantas implant? I never heard about it. .?Is it covered by insurance? Thanks

Nalakrats
Nalakrats
in reply to Etoile3

You can Google it! It is a small 1.5 inch very thin implant--that goes into the under part of the inside arm. It can stay there for 15 months according to the Manufacturer. But of my 3 Docs. they all report, leaving it in up to 2 and 3 years. They can tell it is still working by the fact your Testosterone is under 20 ng/dl, or that you are castrated. If you go on a vacation, you have a fast rebound of your Testosterone. Unlike the Lupron Depot, where it takes 6-8 months to clear the body. I.E. in my 2018 Drug Vacation, my T in 30 days after removal was already 300, and by month 5, I was over 700 ng/dl

Also I cannot find it---but one of our Posters, found a study in response to something I wrote, that showed that the side effects were least with the Vantas implant than any other Lutenizing Drug/system. My Uro, who does the procedure that takes about 5 minutes, has been using it for well over a decade.[Over 1200 applications]. It can be taken out in 5 minutes, whenever there is a reason to do such. I have an MO, 2 hours away in Charlotte, who just put one in, for one of the members here. And my Local MO, has been using them for over a decade also. So as I have said it must be something we do in North Carolina?!*

Do your own research--but there are not many Doctors, that will use this, as they prefer the shots. And many of the younger MO's claim to not knowing of it. Every shot is x-Dollars, the implant is a one time cost for 1-2-3 years. Covered by insurance/Medicare--->Yes

I have Posted on this many years ago, but we have so many new members--that I and other Posters have to repeat ourselves. Malecare/HU, has a search app. that allows you to search terms.

Nalakrats

accessdata.fda.gov/drugsatf...

A plethora of Eligard Info.

Jc

I’ll message you additional info!

This study I think shows that the initial drug surge is lower for Eligard that Lupron and Eligard delivers a more even dose. Please let me know if I’m not understanding it correctly

ww.ncbi.nlm.nih.gov/pmc/art...

cesanon
cesanon
in reply to Danielgreer

can you report the link along with the title of the article. The link appears to be a bad link.

cesces
cesces
in reply to Danielgreer

I was thinking, maybe an initial surge is a good thing.

Title: Pharmacokinetic and Pharmacodynamic Comparison of Subcutaneous versus Intramuscular Leuprolide Acetate Formulations in Male Subjects

I’ll try and resend the link

Medicare covers mine

My preference was for Eligard. However, whether it was Lupron or Eligard, depended on available inventory.

GD

I take monthly injections instead of the 3 or 6 months or 1 year. I did this based upon some research we did when we could find NO research and findings were released by the drug maker, nor would they respond when we contacted them in order to obtain this information.

Further, depending upon body size and other factors, I would suggest that the longer the drug is in your body, the more likely that it will released faster or slower than designed, thus leading to a greater chance of inconsistency in results.

So, a greater cost for the 1 month, yet more needles but I taken this approach.

I also only stay on the combo IHT I undertake for three or max four months, which in most instances, had my Nadir reached.

1. "Further, depending upon body size and other factors, I would suggest that the longer the drug is in your body, the more likely that it will released faster or slower than designed, thus leading to a greater chance of inconsistency in results."

Seems logical

2. "NO research and findings were released by the drug maker, nor would they respond when we contacted them in order to obtain this information."

Hmmm so they don't want the Docs or patients to know about this. They are defensive about stability. That would indicate there is some kind of problem with stability that they are hiding.

3. So the question is what incorrect assumption will make them more money? Hard to speculate on that one.

Was on lupron for a year then doctor switched me over to Eligard. They both worked lupron shot in my butt hurt for a week or more. Eligard shot in my belly hurts like all get out for a while . Can’t tell the difference in what they do. Have Medicare and a part D. Since I get the shot as a in house procedure it’s covered by insurance.

My doc switched me from Lupron to Eligard last year. Result on T-level seems to be the same (<10). My Eligard shot is given every 3 months in the butt. Try relaxing the muscle before the shot by standing on a stool and letting that (soon-to-be-shot) side leg hang free.

I feel like an orphan. My MO has me on the 4-mo Lupron shot. I've heard rumors that it's not "as effective" as the 3 mo, but I can find no proof. I've asked on this site, but no one has answered. Any body have any info on the 4 mo shot?

cesces
cesces
in reply to herb1

Herb1, no one knows the answer except the manufacturer. And they aren't talking.

I have given this thought. I think it's safest to go mid-range.

3 months and 4 months are both basically mid-range.

herb1
herb1
in reply to cesces

cesces: I wouldn't worry, except my psa is no longer going down to ND; it's hung up at about 0.4 (21 yrs after diagnosis with GS6, T2b, so, again, not really too worried). I did get one Psa after 3 months and it was lower (0.3, vs 0.4).

I've been on both.

I am currently on 3 month shots, always have been.

Insurance paid for both.

My PSA was stable with both.

My only issue, and it may be just me, but the injection of Eligard hurt like a MF'r.

To me it was worse than a wasp sting plus the pain lasted full strength for about 10 minutes. And then it took up to an hour for all the pain to dissipate.

After the second injection of Eligard I demanded to go back to Lupron.

The doctors office said the only reason they went to Eligard was due to Lupron being more expensive. But they happily put me back on Lupron.

I've been on one or the other for 6 1/2 years and except for the occasional ADT vacation, my PSA has stayed under 1.0.

You may also like...