Switching from Lupron to Ogovyx

[roboocme]

Has anyone here switched to Orgovyx (relugolix) pills from Lupron shots? Is it advisable to do so? Is there a huge cost differential?

[JohnInTheMiddle]

I know that the search capability here is not the best but there are some good posts and replies on this. I wrote some of them. One key question is convenience versus actual scientific difference.

[roboocme in reply to JohnInTheMiddle]

Thanks, JohnITM, I will attempt a search. Have you done such a switch?

[JohnInTheMiddle in reply to roboocme]

Hi Robo - I am on Firmagon which is like Orgovyx also an antagonist. But it is injected not a pill. In Canada Orgovyx not on our public Health formulary yet. I had been strongly suggested to switch to Lupron. And after a lot of research I decided not to switch. And to stay with Firmagon. I think I would love to be on Orgovyx.

As for search, my notes have mostly been as replies. I would like to make them as original post and then they will be easier to find. I'm going to make a list of them and then it will be easier for me to share an answer to any questions such as yours. (My sense is that MaleCare hosts are eell aware that the search capabilities on HU are lacking, sadly.)

[roboocme in reply to JohnInTheMiddle]

Thanks for again responding. I am on Lupron but might have the option to switch to pills if my MO concurs. My health plan and Medicare give Orgovyx as an option. I am weary of the shots, some given rather badly.

[JohnInTheMiddle in reply to roboocme]

I have a new nurse and when the nurse gave me the injection it was the best ever there were no side effects at all! (No sight pain or swelling, and oddly no fever. Only tiredness but not as much.) Never happened before! Interestingly the Firmagon injection was on my side in a love handle, not in the stomach fat. From my experience and reading it's my view that Firmagon must be done carefully and that the skill level and care of nursing people is not consistently high.

Until recently I've had monthly blood tests and I would say one in four they do it wrong and it's painful and there's bruising and I'm thinking they're wrecking my blood vessels.

[hansjd]

I've been on Firmagon for 5 1/2 years. Occasionally the injections are poorly done and I have some side effects for the next 12 - 36 hours, but I've learnt to be rather assertive and make sure they do it as well as possible. I do my own injections when we're travelling so I'm well aware of what's required to minimise side effects.

Having said all that I would switch to Orgovyx if I could. One pill a day appeals compared to monthly injection. It's also an antagonist (not an agonist) and therefore gives better results for PC (previous trial compared Firmagon to Lupron and when Lupron was failing participants were switched to Firmagon). It also has a better cardiac 'record' than an agonist. Unfortunately in Australia while Firmagon is on our PBS and therefore free, Orgovyx isn't yet. So monthly injections it is.

All the best from OZ.

[JohnInTheMiddle in reply to hansjd]

Super thanks for your fantastic and informative reply.

[Amadeus71]

I started out with monthly lupron injections, but then made the change to Orgovyx after 5 months. I've been on it for 16 months now. Side effects such as hot flashes are definitely less noticeable with Orgovyx.

[ron_bucher in reply to Amadeus71]

Did it help your energy level?

[Amadeus71 in reply to ron_bucher]

Can't say for sure. Regular exercise does help me maintain energy/fend off fatigue though.

[Doyourhomework]

Hi,

My husband has intermediate risk prostate cancer. He was told to go on Lupron for 6 months -two 3 month shots and radiation after the first two months.

He was very uncomfortable about the potential side effects of Lupron for 6 months. He kept questioning the doctor (at a major Boston hospital) by email, about the side effects and how he would feel.

Low and behold, Orogvyx for 4 months came up as an option. Its an oral pill, you take everyday yourself, has lower cardiac side effects and clears from your system faster than Lupron. No painful shots at the hospital. Less time from work. Why was 4 months now OK, when he was told he needed 6 months of hormone deprivation? He would have had him suffer two more months of side effects.

I did a lot of research and found out Orgovyx was approved in 2021 by the FDA. Lupron has been around since the 1970's but hasn't become generic, as they keep making slight changes to keep their patent going. So the price hasn't become cheap. But if you get a shot or they charge it as an infusion at the hospital, they make much more money, than if you get an oral pill at a pharmacy.

I asked why Orgovyx isn't now the standard of care, since it is much easier on the patients...the doctor didn't answer my question. He tried to back track and say he was trying to save us money. How about letting us decide?

If you take Orgovyx you pay what your insurance copays or coinsurance are. My husband is on Medicare with RX insurance. He's on it for 4 months. The first month was about $1050 (covering the Medicare deductible, too) and the next one was about $550. We expect another $1000, so it will cost him about $2500 for a tier 5 drug from Medicare for 4 months. In his case, well worth the money. So far he has loss of libido, a few hot flashes each day (very manageable) and a bit of loss of strength at the gym. He has been weight lifter and gym goer his whole adult life.

You get Orgovyx from specialty pharmacy. The doctors orders it from one. I don't know why. I could easily research the cost of the drug on our CVS Caremark plan. But we got it from the Mass General Specialty Pharmacy.

You can/should ask the doctor's office/hospital if you will have any out of pocket expenses for Lupron shots. I think if you get a drug in a hospital setting, it is charged differently. We didn't even bother trying to find out. My husband clearly wanted the shorter option. Lupron shots only come in 3 and 1 month dosages. So you get a long acting drug instead of something that starts clearing the day you stop taking the pills.

Do your homework. Good luck!

[j-o-h-n in reply to Doyourhomework]

I did......... but my dog ate it.........

Good Luck, Good Health and Good Humor.

j-o-h-n Tuesday 10/10/2023 6:24 PM DST

[Explorer08]

I’m on my second cycle of Orgovyx. The daily pill is quite easy to deal with. Side effects minimal. I pay $72.30 per month copay. I’ve never had any of the injections and plan not to.

[Hawk56]

On this go around I am on Orgovyx vice Lupron.

I think at this point, six months in, I believe the SEs are less...yes, still experiencing hot flashes, fatigue, muscle and joint stiffness, genitalia shrinkage but definitely seems less. No loss of libido and with Cialis I can achieve erections.

TRICARE for Life functions as my Part D, my copay is $16 a month.

It only made sense given my CV profile plus the other advantages, no flare, faster and higher sustained castration and faster T recovery.

Kevin

Clinical History

[Jalbom49]

In reply to your direct ask, I finished Lutron two years ago, taken simultaneously with abaraterone. It worked well and my psa went undetectable after a few a few months and has stayed that way forfour years. I was on it for two years.

Having no experience with the oral drug, I cannot comment on it.

The fatigue of treatment was troublesome for me and I have been on testosterone for six months, feeling much better and with no rise in psa.

[FigureGround]

I went from Lupron to Degarelix and briefly back to Lupron before switching to Orgovyx (and Nubeqa). I can't say I notice a difference in side effects, but then that might be the brain fog making it difficult to tell.... I've been on Orgovyx for over a year. Cost can be prohibitive, but check out the Patient Assistance program on the Orgovyx (Myovant Sciences) website.

[j-o-h-n]

Wow....... recently I switched over to a Orgo's daily pill.... and at first I had a hellaofatime injecting them.... But if there's a will, there's a way....

(Hey whatdayawant for free? A junior Seinfeld?)

Good Luck, Good Health and Good Humor.

j-o-h-n Tuesday 10/10/2023 6:39 PM DST

[jackwfrench]

I started Lupron 6 weeks ago with Hopkins and had questioned the Orgovyx option heavily both at Hopkins and Sloan Kettering. The answer I got was that Lupron has a long, successful record and while SE reports are better, Orgo is relatively new and not in the official NIH Standard of Care(SOC), so neither institution would prescribe Orgo . That said, I did find someone else that was less averse to prescribing it so I have it somewhere on my future radar to consider switching.

[VHRguy]

For how long are you expected to be on ADT? Is this for limited-duration primary therapy, or is it permanent, for recurrent PCa?

If temporary, I really have no comment. I found Lupron to be a very easy way to have ADT, one shot every four or six months kept my testosterone suppressed. I had that for 3 years as part of my primary therapy.

When biochemically recurring about 3 years after the end of primary therapy, I restarted ADT. Since my G9 5+4 cancer wasn't something I wanted to take any chances with, I decided I'd go for permanent ADT. Given that, I chose a bilateral orchiectomy (surgical castration). So I have permanently eliminated testosterone, and don't need any ADT drugs at all.

Many choices for treatment, many situations, so the answer to these questions is very often "it depends".

[Tinkudi in reply to VHRguy]

Do you take the second generation adt drugs.

[VHRguy in reply to Tinkudi]

I do not. That however has become pretty much "standard of care" now. I'm not sure what would happen if I asked my doc about it. My plan is not to do so until my PSA ticks up at all.