NRAS
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Biologic Question

Hello, hoping one of our fellow members who is knowledgable in biologics can answer my question.

Enbrel only treats RA

Remicade treat both RA and Crohns

Why? They are both TNF blockers and both work the same way. Is it just that Enbrel wasn’t specifically tested on Crohns?

Is Remicade a more powerful biologic than Enbrel?

I know Remicade is infusion and Enbrel is not, but there are plenty of injectable biologic Crohns treatments so whether it’s injected or infused shouldn’t matter.

This may be an impossible question I know ...

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Found this comparison on google. Perhaps some help.

iodine.com/compare/enbrel-v...

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Thank you Simba it does answer a few questions. 💕🙏

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Simba, the cost comparison of

Enbrel at 4,500 aprox

Remicade 20,900 aprox

My Enbrel is 5,500+ every three months or 22,000 per year.

So would Remicade be 80,000 per year? Do you or anyone know how much Temicade costs per infusion?

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Seems like the infusion cost berween 1300-2500

emedicinehealth.com/remicad...

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Thanks Simba. Now that I know the cost of the actual drug, it’s probably the hospital stay and dedicated infusion nurses needed that drives up the cost. I’m told 6 hours ( first infusion) to monitor reaction and after that aprox 4 hours)

Thank you a million times for helping me find the answers!

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Glad you got it sorted out😊Simba

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Hi hobbits

To say enbrel only treats RA isn’t accurate. It’s also used to treat Ankylosing Spondylitis?

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And PsA!

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Yes, sorry. I was referring to my own particular diseases of RA and Crohns. I take Enbrel for RA and they want me to switch to Remicade to treat both.

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And wondering why exactly Enbrel can’t treat Crohns if they work by same mechanism by Being TNF blockers.

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I was taking Enbrel for PsA but I also have Lymphocytic Colitis. Clemmie

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It's probably like everything else in the NHS at the moment it all comes down to money, like me I'm on Benepali when I should be on Embrel but due to the cost they go for the cheaper option, but sadly it's not working for me anymore so I'm waiting to see when I'll be giving something else

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Poor thing.. When we, the RA patients need the medicines most and yet we are not able to finance what we need, that is the saddest part in life really.

I hope you will soon find something affordable to and suitable for you.

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Hi, my insurance will pay for it so I’m lucky in that regard. I’m questioning whether I really need to switch to a more expensive drug. It looks like it’s not that actual drug itself but probably the costs involved with going into hospital or infusion clinic and having nurses administer the drug and monitor you. And apparently draw my blood at each visit - this making Remicade more expensive.

I’m told I need to switch because my Enbrel I take for RA, will not treat my Crohn’s disease. I’m told Remicade treats both RA and Crohns.

They are both TNF blockers and work by dampening your overactive immune system.

RA being inflammation of the joints and Crohns being inflammation of my intestines.

Both auto immune disease are caused by overactive TNF cells that cause inflammation.....why then won’t Enbrel work for Crohns?

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Good to know that your insurance will pay for your treatment. Over here, my insurance card does not pay for my RA treatment. I am lucky to say that I can get very cheap treatment from our local government hospital, hence I am okay.

For Crohns issue, I do think that it is a very good decision to ask the rheumy directly if it is due to the higher cost or if there is some kinds of reasons behind his decision.

Seriously, I am sorry to say that you have these 2 immune problems concurrently. You need to take very good care of yourself really. It is always easy to say than done, I do know that. I like to say something nice but I know it is so hard over there for you to handle the pain, I know that very well.

Sending you my love and big hug, my dear friend.

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What gives me 'the hump' is that we have to pay for our prescriptions at all! I have RA (seropositive) and I have to pay for everything as I work! I pay for the year (£104 approx currently) by buying a yearly preprescrition card. However, this doesn't help when I need extra dentist and optician appointments, which we all need to keep on top of things, which need paying for too!

I think as RA is a chronic, life-long disease, which we haven't bought on through any life-style choices, we should be exempt from charges and have support towards our extra needs too.

Sorry, rant over😊

Back to biologics: I can't help with the actual ones you're talking about, as I have Cimzia, but in my opinion, one should start on the least 'powerful' as then there is always the other ones to move onto if it has little to no effect. If one starts on Remicade, it's more unusual to move back to Enbrel. When I was first offered a choice of biologics, Enbrel was one if my choices. I was told there are a few more to try if none of the first line of biologics worked but was told also, they are the last line of drugs to try. I hope this makes sense. Finally, I should add, this is something to discuss with your rheumatologist and/ or clinical nurse as they are the ones who are armed with answers.

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I don't know the answer .....but being on a Biological drug I do know that each cocktail of Biologics does not just depend on the effect of a particular Drug you read about. I have a blood test the week before an infusion to decide the mix & the speed of the infusion......my Rheumy decides that.

It depends on many things besides your RD condition......your health history from childhood &, NY other condition you have & the way you have reacted to different Dmards is considered. Biologics can be tweaked by mixing with xyz....to come up with what a rheumatologist considers the best for his patient.

If you are being considered for Enbrel or Remicade make a list of questions & get anapointment to discuss everything with your Rheumy nurse.It takes a certain type a doctor to become a Consultant Rheumatologist ....as we know they are very thin on the ground.....so if/when you need to consider Biologicals......take his advice.

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I’m currently on Enbrel by my Rheumy for RA.

Gastroenterologist wants to switch me to Remicade infusions for Crohns and I’m told it also treats RA.

I’m wondering about why Enbrel only works for RA, since both biologics block TNF cells why would both drugs work for both diseases. RA being inflammation of the joints and Remicade being inflammation of the intestines both autoimmune conditions are caused by overactive immune causeing inflammation.

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Once again I don't know the answer you must ask your Rheumy, but if you are in UK try not to mention RA because Private medical insurance will not pay for anything connected to that....they regard it as an incurable condition & just refuse to entertain it.

A friend has just quit private medicine because she was paying out more in insurance subscriptions than she received treatment, she now pays herself & is better off...especially being free from the inquisition insco's ask when you ask them to authorise treatment!

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I don't know but my niece has only Crohns and is on Enbrel

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I am told that Enbrel is not a designated drug to treat Crohns. I currently take Enbrel for RA prescribed from my Rheumy. I was just diagnosed with Crohns in March 2017 and being told I need to switch to Remicade infusions (which cost 4x as much money) because Remicade treats both RA and Crohns.

My question is asking why if both biologics work by targeting TNF cells, why wouldn’t Enbrel work for Crohns? Are TNF cells not the same throughout your body, the cells that over react in autoimmune conditions and cause inflammation?

I’m trying to understand the science of it.

Ps. Blessing to your niece with Crohns, not an easy path I know...

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It all comes down to money all the time.when I was on biologics they kept going on about it being £10,000 each.

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I'm on a combination of Benepali and Methetrexate but they have stopped working so I'm going to tell them on Monday that I'm not putting anymore of that stuff in my body and want switched to something else as it's hampering my recovery, I've found out with the Rheuatology department that you have to be polite but show no weakness or they will just fob you off to get you out the door

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As I understand it, the whole way these drugs work is more complex than every anti-TNF drug blocking the same TNF inflammatory molecule in your body. It's a whole chain of processes associated with the TNF and there is a variation in how that chain is disrupted according to which drug is used. There's also a TNF alpha and a TNF beta.... and they bind to LTalpha and FCR molecules etc etc.

Here's a description of one process (I have a nifty diagram but it won't let me paste it into a reply) which gives you a taste of the complexity....But in a nutshell, each drug does do something slightly different.

TNF and TNFRs. Complex interplay between soluble and membrane bound TNF and LTα ligands, and their cognate receptors. Membrane TNF is cleaved by TACE to produce soluble trimeric TNF that binds TNFR1 and TNFR2. Membrane TNF also binds both TNFR1 and TNF2 molecules. Another TNF-ligand cytokine LTα is secreted as a homotrimer and/or found as a biologically active complex in association with membrane bound LT-β. LTα binds TNFR1 as well as the herpes virus entry mediator HVEM but not the LT-β receptor.

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Thank you so much helixhelix. I did ask the specialist, but she was not able to answer my question and admitted she didn’t know exactly.

I think your answer is the very best I will get. I want to know what I’m putting in my body and how it works, therefore making the best informed decision.

I currently take Enbrel and they want me to switch to Remicade. I have refused but I am now being to I really have to switch as the Enbrel that is helping my RA is not helping my Crohns inflammation.

I’m scared to switch because Enbrel is really working good to control my RA. I don’t want to upset that. I thought if Enbrel biologic works for my RA (inflamed joints) why wouldn’t it also work for Crohns ( inflamed intestines) since biologic drugs are used to treat both. But I’m told Enbrel will not treat Crohns, but Remicade will.

If I rock the boat and switch, I take a huge risk not knowing if Remicade will actually work as good as Enbrel for my RA. I’m terrified my RA symptoms will come back, and when it’s bad, it’s bad! I don’t ever want to go back there! I also know once I switch, I can not go back to Enbrel to treat my RA. I have already been told this. It also makes me nervous, my Gastro prescribing drugs for not only my Crohns but also my RA. I’m told the reason being is a Rheumatologist can not prescribe Remicade in the strength I need, but my Gastroentrologist can.

There is no guarantee that Remicade will be a biologic that even works for my RA. I may be loosing the one drug that actually was able to get my RA under control. It took years and many, many drugs to find one that worked, and now I’m told I have to switch. Neither specialist could explain why one biologic works for Crohns and another doesn’t. I need to know that there is a real good reason to switch me off a drug that is working. I didn’t understand why one TNF blocking biologic was so different then another since they both lower your immune system by blocking TNF cells. I’m no scientist but your reply does answer my question because it looks like different biologics all block TNF but in slightly different ways.

Humira was my very first biologic I tried for RA and I’m told that Humira also treats RA and Crohns, ( although I was not diagnosed with Crohns then) but I had a very terrible allergic reaction. Then I went to Enbrel it was a godsend for years. Now I’m badically being forced to switch to Remicade.

My Gastro has given me some time to make the switch as she understands I’m scared and confused and resistant to go off Enbrel and I feel like I have no control or say in anything. Knowledge is power, so I’m trying to understand the drugs, so that I feel I’m making an informed decision. But it doesn’t make me feel confident when the people prescribing the biologics can’t even tell you the difference between two biologics!

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ac.els-cdn.com/S13596101140...

This might work? Anyway long and convoluted paper but if you look at figure 2 on page 5 there is a chart of some of the biologics which shows their different structure and a bit about the different things they do.

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Thank you!

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