Is there any difference in cost/effectiveness? My urologist wanted me to start hormone therapy with Firmagon, but my radiation oncologist wanted me to go on Orgovyxx instead...any thoughts? Thank you!
Firmagon vs Lupron vs Orgovyxx - Advanced Prostate...
Firmagon vs Lupron vs Orgovyxx
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SilverSeppi
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Orgovyx and Firmagon act to stop testosterone production in exactly the same way - they are both GnRH antagonists. Orgovyx is a pill that you have to take every day, while Firmagon is a monthly shot. Firmagon is covered by Medicare Part B, while Orgovyx is covered by Part D (for which there can be substantial co-pays). The downside of Orgovyx is compliance - missing a couple of days can allow testosterone to be quickly restored. The downside of Firmagon is injection site reactions.
Is either Lupron or Firmagan better than the other, or too close to call?
Either
my initial doctor wanted me to get Orgovyx but my private insurance declined that so I got an Eligard injection instead (similar to Lupron). So I assume that Orgovyx is more expensive. I’m going on Medicare Nov 1 and I’m going ask my current doctor / oncologist his opinion. I would prefer a pill. With the upcoming out of pocket cost limits under plan D of Medicare, cost is not as much a factor anymore especially since I will hit the new out of pocket very quickly with my Nubeqa. I’m going to go with whatever my oncologist recommends.
As was pointed out in an earlier comment above, Orgovyx and Firmagon are GnRH "antagonists". Eligard/Lupron are "agonists". They both suppress testosterone, in different ways. And the first group are in research associated with better outcomes where cardiovascular disease and skeletal risk are concerned. The choice is not merely a question of convenience. Many people just take what is recommended to them by their doctors without realizing the consequences of this important choice.
Yes, agree, and thanks for clarifying. Definitely going to inquire on this with my MO who was not involved in the initial medical decision.
No side effects from Firmagan? I've heard different opinions.
Of course there are effects with the Firmagon. I'm in bed for 36 hours with a fever once a month. And I have a painful stomach swelling that goes away in a week. And the usual side effects of all ADT. I claim that the large amount of exercise I do combined with low carb may have helped me minimize my side effects. Who knows? I know lots of other people have reported much worse side effects.
Thanks. I've done fine (generally) on generic Lupron for 5 years. I do worry about long term effects on muscles and bones, but generally doing well. I guess each med has its own effects, and each patient reacts differently.
in reply to Bret5
Orgovyx is a "tier 5" with Medicare, you'll be paying 33% with most Part D policies.
Unsure if a Part G will foot the 33%, do your shopping!!
Bret5 in reply to
You may have a typo in your second sentence. Part G supplement has nothing to do with pills you take at home.
That said, be aware the law is changing on part D in 2024 and again in 2025 and beyond. There will now be an out of pocket limit on drug costs. This will greatly reduce 12 month cost for high dollar medications especially for some of us who take multiple tier 4 and tier 5 drugs.
in reply to Bret5
Yes my error.
Eligard affects many patients with more severe side effects than Lupron. Also read my other replies to this post
in reply to Bret5
Hubby is on traditional Medicare and has Part D and Part G. Firmagon not allowed as it is Tier 6 med. Part D would pay $1500- of the monthly $2500 Orgovyx price--it was left up to hubby to come up with the additional $1050- monthly. He decided, instead, to go with Lupron, but the monthly injection vs. 3 month injection, as SE seems to be less with the monthly shot (it starts off as a lesser dosage, obviously) but surprisingly was 1/2 strength the dose of the 3 month injection at the end of the dosing course. Which told us that the body excreted it faster, or it was metabolized faster. Regardless, looking at the the medical facts sheet included with the product, SE were less on the 1 month injection.
ImaSurvivor1 in reply to
Insurance is a mystery. I'm on Firmagon injections every month. I have traditional Medicare and Tricare as my secondary insurance. I don't pay anything out of pocket for it. Makes me wonder if your doctor didn't advocate for you with your secondary insurance or if you need a better insurer.
TriCare is great but only available for veterans
So, Firmagon is a viable alternative to Lupron? but not as good as Orgovyxx? or equal? still confused, sorry!
I'm on Firmagon almost 2 years. It was original specified because I was in an emergency situation. Masses were pressing on my spinal cord. But Firmagon works fast. That's what they give it to you in such a situation. Then you have to have an injection every month in the stomach. I have tolerable discomfort for a day (it's very important that the nurse follows the injection protocol exactly).
All of Firmagon, Orgovyx and Lupron (or Eligard etc.) are how you do ADT therapy. If you don't have "an emergency" on diagnosis then it's likely you'll get put on Lupron or Eligard etc. at the beginning. Which is only an injection every 90 days.
Here is a comparison:
1) COMMON PURPOSE -- All these meds suppress testosterone and constitute ADT therapy against prostate cancer. You and your doctors can decide which is appropriate for you.
2) TECHNOLOGY -- Both Firmagon (aka Degarelix) and Orgovyx (aka Relugolix) are GnRH "antagonists". On the other hand Lupron or Eligard are GnRH "agonists". Research indicates that there is a difference in impact on the body where CVD and osteoporosis is concerned. There is some evidence that a GnRH antagonist is better for your heart etc.
2) METHOD OF ADMINISTRATION -- Firmagon and Lupron are injected. Firmagon is every 30 days or so, but Lupron can be every 90 days or even more. On the other hand Orgovyx is a daily pill.
3) HOW NEW IS THE MED? Orgovyx is much newer than injectable ADT therapies. As a daily pill it is very attractive for some people.
4) COST -- Orgovyx seems to be enormously more expensive than the other meds.
5) CHOICE -- Your doctors are BOTH recommending one of the "antagonist" meds. One is injectable and one is a pill. Both have great research behind them.
In my case I was encouraged -- "for convenience" -- to switch from Firmagon to Eligard (like Lupron). After a lot of research I decided to stay on Firmagon. My doctor supported this.
Just to add to JHMX's points:
The intent of all the ADT drugs is to suppress your T levels to castrate level, historically < .5 and in the modern era < .2. All the drugs should get you to <.5 but with different side effects due to the different drugs mechanisms (these are different than the side effects due to T withdrawal which are pretty much the same across all the drugs).
Firmagon is often given as a first treatment to newly diagnosed PCa because it acts fast (measured in days) and doesn't have the SE of Testoserone flair (initial increase of T level) which lupron has.
After starting on firmagon it is then common to switch to an agonist (lupron, eligard, etc). So after 1-3 months or you can choose to switch or stay on firmagon.
Firmagon and Orgovyxx are equally effective and there is no efficacy reason to choose one over the other. Firmagon is an injection given every 28 days at your doctors office or an infusion clinic, US$ street cost $600 for 28 days. Orggovyxx is a pill taken daily (at home), US$ street cost $2600 for 28 days.
I started on firmagon and decided to stay on it ( 9 months now) because I tolerate it well. If you choose firmagon you will start with a double dose (2 injections) which I found really painful for the first 2-3 days, but I haven't had any real complaints since.
My medical oncologist told me that the side effects from orgovyxx are less than that of any other testosterone reducing drug, especially the long-term effects on cognitive disability
"cognitive disability" - that's very interesting.
FYI pcf.org/c/interview-with-an...
Fantastic - thanks for the share - I actually had a baseline cognitive assessment last month.
Husband had been in lupron 3 years, what it has done to his mind is scary. Docs at home just shrugged their shoulders, luckily we had the opportunity to go elsewhere and lupron is history. Not sure what the new protocol will be, they're just doing initial testing now. First docs to actually do a pet scan
in reply to Spring15-3
Curious to know, where are you now? And now your husband is off Lupron, have you noticed an improvement?
Spring15-3 in reply to
He's only been off about 3 weeks but I'm seeing flashes of his own old self. Doc told me it will take months to totally wear off
My T never got that low. My T was like 5 to 8 range
Think T needs to be less than the 30 to 40 range in ADT to effective in lowering your PSA.
Dr did not seem to interested in monitoring my T level
Sorry
Canada .5 nmol/L = 14.5 US ng/dL
Yes there are different "measuring sticks" I'll call them which you may see on a testosterone test report as you mentioned, patients need to be aware of this when interpreting their results.Typically you testosterone needs to be less than 50ng/dl to be considered castrate. But under 20ng/dL is the goal and produces much better results. The various injections like 3 months, 4 months, 6 months all have charts that show how they wear off.
So often the testosterone blood tests we get are often when we go in for the next shot. The values can vary a slight bit from shot to shot as well. So by the time you get your shot, your T value might be higher than it is mid way through the time period.
So no reason for alarm if on one test your T is 11 and the next time it's 18.
Yes, point I was trying to make but garbled in the delivery on the 50 vs 20 ng/dl. Thanks for helping clarify.
my PSA using Orgovyx for 18 months new is averaging .14 with a T of 16 (this is the average over the period including the initial period of reduction prior to radiation (mestastasized 5 years after surgery) ... side effects not as bad on my heart (aneurysm and damage due high blood pressure ). Efficacy is the key for me, as I cannot take Lupron (heart) or Xtandi or Yonsa (same issue)
I've actually be had to tell a nurse or two how to prepare the drug (Lupron) before injection and how to inject it slowly. My very first injection I was butchered with the injection which I had pain from for many months.Not just any fool can give you the injection.
That’s bullshit. You need to get a specialist to inject. I travel two hours to get my injection because they need to know what they are doing.
Gsun your response is not only offensive but wrong. I have on multiple occasions had to instruct my nurse to tap the vile with her finger nail and continue to do so to mix up the solution.
I one case I could tell she was new and young so I helped both her and myself out by doing so.
I go to multiple hospitals and some have a specialist who gives the shot, but other times it a infusion area that does it. Other times it will just be my nurse.
My first injection was done by a "fellow" doctor. Correction I believe that person was just a male nurse. I had never had one before and didn't know what to expect. So I couldn't tell him he was doing it wrong. I had pain for many months.
I've never received an injection like that again. If given correctly you'll hardly feel it.
Offensive? hardly. Wrong. Nope. I go to a specalist that gives me my injection. She is a representative of the company that makes Lupron and does that and infusions only. You can't expect a nurse to know everything. There is NO WAY you should have to instruct anybody on how to give the injection. The powder has to be mixed with the solution just so or you will get pain and it will not work as intended. You can make excuses for poor traing all you want. I would not accept it.
I totally agree, we are not guinea pigs for uneducated/inexperienced medical practionists of any kind. This is serious $hit.
Your in Canada, we are in the US where health care is not universal, not a right, and the healthcare corporation bottom line wins over having a fully trained capable and confident person giving you your injection.
You cannot know my experience in the US.
Speak to your own experiences do not derided others with offensive language in this forum.
Sorry. You should have an experienced person taking care of you. Full stop. Why are you defending poor quality care?
I'm in Canada and my experience mirrors TJGuy in the US. I get my monthly firmagon injection at Coverdale Infusion Clinic (as I guess so does gsun), this is a private sector provider across Canada and all/most of the provincial plans outsource the hands-on to this company, they are 100% profit driven. The nurses are part-time contractors and the pay is less than in the regular hospital system with worse benefits (you can see I got to know my nurse pretty well and she is excellent; and she also does shifts in the regular system). Last visit I was served by a Trainee who had only given Firmagon once before so I discussed the whole process with her before letting her give me the injection. This didn't bother me, although I'm older now I was young once - everybody starts naive and inexperienced but develops over time.
I am NOT in Canada, I am in the USA where we have the BEST medical practioners IN THE WORLD.
Dream on.
commonwealthfund.org/public...
Tell that to the Mayo Clinic and Johns Hopkins and UCLA and Memorial Sloan Kettering and Mt. Sinai and New York Presbyterian and Robert Wood Johnson etc etc etc
So I've been to MD Anderson, Mayo, Memorial Sloan Kettering, UCLA, and others for my treatment. I'll let you guess where I got the injection that hurt for Months.
eligard is a shot in your abdomen gut and last up to 3 mos like Lupron depot. Stings for a few seconds then goes away! If you don’t have any gut, it’s more painful. So, drink a few beers before getting the shot, ha ha. Lupron is administered in the muscle and was near your butt butthey changed injection site closer to the hip as they found that some patients were getting sciatica as a SE.
Stay strong
And old Japanese saying...
All paths lead to the top of the mountain, for those that arrive, the view is but the same!
Pick your poison! Same desired results, different effects by each person experienced...
Good Luck!
I get a 3 monthly Prostap (lupron) shot in the thigh and have no problems at all from the injection site.
My husband had a very bad reaction to the Firmagon injection. He is unusual in that he has issues with any injectable medication. His BP bottomed out and he needed resuscitation. Not an allergic reaction just issues from prior surgery. He was put on Orgovyx instead and our insurance said it needed to be dispensed from a specialty pharmacy, in our case Biologics. They have a program that you can get a $10 co-pay for 6 months. We are not retired or on Medicare yet. The medication has had very few side effects so far, been on it since May.
Hi, did you need to do anything special to get the Orgovyx for $10 a month? provide proof of income, etc.? or did you just go to their website and create and print the coupon? Thanks!
even with Medicare, the manufacturer has plans ... my copay for Orgovyx is $ 0 now, was $10 / month as just stated by Silver. I am on medicare ... don't give up due pricing, they all have similar low co pay options based on need.
It was handled through his Urologist; they applied on our behalf.
I’m surprised more people don’t mention that if someone isn’t in a high-income bracket they can get Orgovyx free from the manufacturer for at least a year or even longer. Then given coming Inflation Reduction Act cost limits, one can more easily afford the newest, most convenient mode of ADT. It helps to have your medical team persistently backing you up, of course.
Ive been on Orgovyx for 2 months. I had a blood test after 3 weeks. Test went from 385 to 0. PSA dropped from 47 to 7. It works quickly and I have had zero side effects except some muscle loss. Once you stop Orgovyx, your test will come back quickly unlike the other ADTs. Downside is that it costs $3k per month and my indurance only covers 2/3 of the cost. The key to being on an ADT is to work out hard everyday. I also take a muchroon tincture snd several supplements and i am convinced that is why I’m not experiencing any of the side effects that most men experience. Started radiation yesterday. 26 more sessions to go! Praying for you brother!
I just got a copay card from Orgovyx directly. The specialty pharmacy (RX to GO)helped me get it done over the phone, otherwise it would have been a long drawn out online process. It pays the $1087.00 copay for me.
I have few SE's, Fatigue some quick hot flashes. No muscle loss that I can tell. I go to the gym 5 days a week. My PDA dropped from 51 on 6/1 to .945 on 7/25. T was below close to 0 as well.
Congrats on your first post and welcome aboard and enjoy the cruise.
Are you planning to be on Orgovyx for a short term like 6 months or are you a long termer i. e. 12, 18, 24, or 36 months. Since I am on Lupron for 6 months only prior/after radiation it was cheaper to do the shot.
You might ask if you can go back to a lower level drug in the future. I do not know the answer to that. It just came to my mind because most start at a lower level and work their way up the chain of drugs. Orgovyx seems to be at the top of the chain.
If cost is a issue perhaps switching would help but then you are then going from a pill to a shot. Convenience vs Cost trade off.
Welcome abroad!
Thanks! I am just starting on this journey, I believe at this time that the plan is for me to stay on ADT for somewhere between 12 and 24 months; not sure what the determining factor will be?
The comments here cover the convenience aspect, the potential injection site issues with Firmagon, cost, agonist vs antagonist etc. All important things to consider.
Unfortunately, your doctor’s claim that Orgovyx has less side effects is a dubious one, if for no other reason than the drug is too new for anyone to know.
It is possible of course, but keep in mind Orgovyx suppresses testosterone the same as the other drugs, and that suppression is the root cause of all the SE.
Your fitness habits, weight lifting in particular, will have orders of magnitude greater effect on side effects and their severity than what drug you choose. Sarcopenia (muscle wasting and fat gain from slowed metabolism) is the driver of the fatigue these drugs are known for. Fatigue is the prime enemy, as it makes it more challenging to move, creating a vicious cycle unless you intervene diligently. Exercise lessens any cognitive impairment as well. This is what your MO should be emphasizing, well above drug of choice.
Also Important to reiterate that Orgovyx leaves the body much faster than the other drugs upon cessation-bad if you miss doses, but good for regaining testosterone should it be appropriate to stop.
Fantastic mention of sarcopenia and of exercise. These should be mentioned and engaged with much more often. I had to come to focus on these things on my own - the medical world wasn't much help.
I believe there are some studies to support the doctor's opinions re Orgovyx. Dr. Soffen is an experienced and very published doctor and I trust his opinion is not pulled out of the sky.
I’d like to know what it was actually pulled out of then. T suppression is what it is. There is no colder ice.
The side effects are what was studied
Sure, ok. My question remains: What is the mechanism of action of Orgovyx that supposedly results in fewer side effects and/or lesser in severity?
Side effects are self-reported. This means a lot of potential placebo effect in play. I suspect that pill vs injection entices the perception of lesser sides. It is human nature to want a better result from the unfamiliar.
Again, I just don’t know what about the drug itself could possibly be different enough to make that kind of difference. I am trying to keep an open mind.
I've wondered many of the same things. I've been on Lupron 5 years with not terrible side effects.
Every man getting on ADT should know his baseline testosterone first. Inexplicably some doctors don't order one and often the patient has never had it tested. This is no good, and obviously it is a factor. Some men don't have side effects because their T was already so low that suppression made little difference.
Others are simply much older and even if T is relatively normal for their age, it's usually somewhat low from aging alone, and sometimes having it lowered isn't that noticeable.
Libido, function, ambition and the other aspects of T also figure prominently of course. At any age (but especially older) some guys just don't have much drive, aggression, interest in sex or a combination. More are like this than is known I suspect. I can't know but it seems this would affect sides as well.
At the end of the day, it is an individual experience to be sure, and there's a wide range of side effect profiles. Still, I strongly believe that the more fit and strong a man is, the better able he is to thrive on ADT. It's what I observe, but it's also supported by data and is entirely logical. MO's do not talk about this enough with their patients.
Again, physical strength and cardiovascular health are a much greater factor in combatting side effects than which ADT drug is chosen.
True but the drug can have MAJOR effects on both effectiveness and side effects; everyone is different.
They all can, but at this point differentiating Orgovyx from the other LHRH drugs in terms of side effects is conjecture. Same with effectiveness. For instance, there is really no way to reliably know if some self administered daily doses are accidentally missed, which in some could explain T levels not remaining at castrate level. Old people all have memory issues to some extent.
Not according to my medical oncologist and I trust him implicitly more than I trust. Internet jabber
Do yourself a favor and be as fit and strong as possible. It’s more important than the drug you choose.
Ask your oncologist what he thinks of that. If he says it isn’t so I have some data for him.
in reply to London441
That's a great point, I've wondered the same. If there are 2 men, one 50 yrs old with a T level of 900, and the other 70 yrs old at 300, it would make sense that the older man with 300 would have an easier time of having the T levels reduced further, and therefore, fewer SE. Of course, there are other factors to consider, but all things being equal...
I used both Firmagon and Orgovyx. Same ADT effect for both...painful monthly reaction to injection with Firmagon versus just a daily pill for Orgovyx .......your choice.
My experience: Elected for Orgovyx first as it seemed easier to take a pill vs going in for shots regularly and the reported side effects were less. However, after 4-5 weeks it was ineffective in lowering my T below the 250 level. Also started Abiraterone. As I was scheduled for RT my doctor moved me to a 1 month shot of Firmagon (works quickly, and Lupron can cause an initial rise in T). Injections were in the abdomen and leave a little bump that dissipates as the system assimilates it over the month. Worked great, T level dropped to <10. Then moved onto 6-month Lupron shot (in the lower hip) and all has remained in great shape since.
I have only had mild Hot Flashes once in a while and after more than a year a bit of Fatigue once on a while. Blood tests have been excellent and my doctors find that my exercising and activity level as well as eating a Mediterranean diet have all contributed to low side effects and good liver, kidney, heart tests.
My thoughts are stay positive, make some adjustments and alterations to your diet. Several men I am in contact with find similar results with adjustments. The plan for me is to come off both medications (Lupron & Abiraterone) in April 2024. I haven't let it stop me, don't let it stop you. Keep open communication with your Doctors and keep them aware of side effects if you have them. There are some methods and treatments to minimize some.
Firmagon plays first base.
Lupron plays second base.
Orgovyxx plays short stop.
WHO'S ON FIRST?
Good Luck, Good Health and Good Humor
j-o-h-n Thursday 08/10/2023 3:34 PM DST
Firmagon is more effective at bringing down and holding down testosterone than Lupron, it will also last longer until failure than Lupron/Eligard.
The reason it isn't the first choice is the monthly injection to your belly area.
Orgovyx is a new oral form that works like Firmagon but no injections. It's performance is shown to be the same as Firmagon. So it should ideally be the choice, unless you have some condition where you can't remember to take your pill each day.
It does not have a initial PSA flare like Lupron.
So since this drug is taken daily, it's up to you to take it daily. Take it first thing in the morning or what's best for you.
Orgovyx takes your PSA down quickly and when you discontinue it your PSA will have the ability to rise more quickly.
For me this would be my choice if on traditional intermittent ADT. I would want it to work right away and then leave my system quicker when I go on the "vacation mode" of intermittent ADT.
So some hospitals might say "we don't recommend Orgovyx, we recommend Lupron etc.
The reason they will say is we like to know the patient is properly on the drug and with injections we know that is true. But most likely is that the hospital, doctor, dept etc make a lot of money by giving you an injection.
The pharmacy makes the money off the pills not so much your providers at the hospital.
Since Orgovyx is new it is not generic so it's expensive. So your health insurance wants to steer you away from it as well.
Welcome to how US health insurance and health care work. Where competing interests, health insurers, health providers, and drug company pricing can keep you from getting the best drug for your health.
If you can make it work and not spend much more I'd go with the pill.
I can pretty much choose the drug I want the cost is up to me and my plans with financial assistance from the company it is affordable, plus Medicare Part D changes are coming in 2024 and 2025 to alleviate the high cost of drugs.
US Health insurance is NOT a problem. I asked for Orgovyx and had no issues or pushback from any doctors or insurance company whatsoever.
i have been looking into switching from Eligard every 3 months to Orgovyx - my insurance says Orgovyx is a 'non-preferred, Tier 3 specialty medication' and claims they can't tell me what it would cost out of pocket unless and until my MO asks for authorization. my MO team says Eligard is covered by my medical plan, Orgovyx would be covered by my drug plan, so likely will be more expensive just because of that.
with financial assistance from the company it is affordable, plus Medicare Part D changes are coming in 2024 and 2025 to alleviate the high cost of drugs.
I'm 7 years from Medicare age- hope to get there, i've got an 11 year old i really want to see graduate high school !
I have been on Firmagon for almost 9 years. Was originally dx with a psa of 209 in 2014 and mets on lower spine. Psa still under total control and no mets. Dr. wants me to stick with Firmagon in spite of the inconvenient jab in belly once a month. If you have a nurse that property injects the med, the side effects are greatly reduced. So what my nurse and I figured out is that a soft spot has to be found on abdomen before injection. Once the spot is identified, I pinch that area and she slowly injects the med . Once she finishes, I keep that area pinched for 30 seconds with needle in place in order for the med to build a depot and not spill into outer dermis which can be painful. Also important to note that she positions the needle at 60 to 70 degrees instead of the 35 degrees that the manufacturer recommends. We have discovered that this injects the med deeper and prevents the painful side effects.
Works for me. I had my injection yesterday had mild discomfort overnight as usual and today I am back to normal
I hope this helps
I am starting on Firmagon next month so was interested to hear of your experience and duration. Glad to have an alternative to Lupron! Will begin radiation in two months. I’m hoping that 18 months of ADT will be enough.
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