Switching from Enbrel to Benepali

[Hezekiah]

Questions

a) Does anyone know if there are any alternative delivery mechanisms available for Enbrel (it seems to be possible to get 2 different mechanisms for Benepali) ?

b) We live in the West Midlands, UK. Has anyone else been asked to switch meds recently?

c) Price differential between Enbrel and Benepali. Anyone know what the savings are?

The list price of originator etanercept (Enbrel, Pfizer) is £89.38 per 25 mg

pre-filled pen or pre-filled syringe (excluding VAT; BNF online, accessed

March 2021). The list price of etanercept biosimilars per 25 mg pre-filled

pen or pre-filled syringe are £82.00 (Benepali, Biogen); £80.44 (Erelzi,

Sandoz; all prices exclude VAT; BNF online, accessed March 2021).

d) Does anyone else have experience of making this switch, and has it been effective?

See below for more information. Thanks.

History: my son has suffered with RD (initially diagnosed as JIA) for approximately 12 years. He had a rough time with Methotrexate, before moving onto Enbrel, which has been very effective for him. A while back he switched to Erelzi (at the request of NHS to reduce costs) but did not get on at all well with it, and the consultant was happy to switch him back to Enbrel. He injects into his thigh, using MyClic pre-filled pens which are delivered by the company formerly known as Healthcare at Home.

He has great difficulty with the injection process (hates it), but is happy with the disease management which Enbrel provides. I suspect it provides him something which might be described as remission.

I've been reading up about Benepali on here, and making notes. I see that many folk recommend injecting into the stomach, using warmed fluid (bra tremperature?) and that there are 2 delivery mechanisms, one of which is fine injection needles.

The current plan is that a nurse is coming next Thursday to show my son how to use Benepali. I don't know whether this will constitute his first Benepali injection, but he is down to 2 doses of Enbrel now.

[medway-lady]

I don’t know about switching medications but did change from the pen to syringe. It was a lot less painful and much easier as it’s my right hand that has always been the worst effected body bit with RA and I could not press the pen down. I hope it suits him I was changed to Abatercept due to a medical issue but it proved that the ABA did not work so well so I got changed back to ETN. It has meant remission and RA sorted.

[Hezekiah in reply to medway-lady]

Which variant of Etanercept are you using, medway-lady?

[medway-lady in reply to Hezekiah]

Benapali

[julie1908]

Hi I have been on Enbrel a number of years now and a few years back my rheumatologist asked me to change to Benepali, but i refused because it took me years to actually find a medication that worked for me and i had no side affects also i had read on here how a few people had changed but it was not working as well or they were getting side affect's from the change.

[helixhelix]

The savings per injection are relatively modest. But if you multiply even a small saving, say £5, by 52 weeks and then by say 5000 patients that would be a national saving of £1.3million a year.

I do know that NHS spend on biolgics is a large chunk of its budget - something like £400 million a year. So if the costs of each biologic in this budget dropped there are potentially very significant savings.

If one could guarantee that these savings would be spent on more rheumatologists then I’m sure many more of us would be orepared to give biosimilars a try!

[Hezekiah in reply to helixhelix]

Hi hh, yes I take your point about small savings monthly multiplied by months and people adding up to useful sums (many a mickle makes a muckle, I believe the old saying went).My son switched to Erelzi in hope of receiving a cheaper just as effective treatment but unfortunately that didn't work out.

My concern is about swapping a very effective med for one which may prove not to work as well, and maybe finding that Enbrel no longer is so effective or that he is prevented from returning to it.

Then again, I don't have to use the my-clic pens every week.........which I believe is the real problem.....and he hopes that the pen which delivers Benepali will be much less painful.

[Paula-C]

I was told a few years ago I was going to be switched within the next 6 months from enbrel to Benepali, a few months later I was told it was going to be Erelzi. I wasn't very happy at all because enbrel took me straight into remission, no side effects at all. I had read numerous posts on here from people who had switched and it wasn't a success, I did my research and typed up notes giving valid reasons why I was refusing to be switched and quoted the NICE guidelines which said at the time it had to be a joint decision between the patient and consultant. These were handed in for my consultant to read and I am pleased to report I am still on enbrel and still in remission.

I have googled the cost of Benepali and enbrel and I will post the link below. It states that 4 x 50mg pre filled syringes of Benepali cost the nhs £656, the cost of Enbrel is £715, that equates to Benepali being £15 per injection cheaper than enbrel. I think it was around £14 per injection cheaper when I was told I was going to be switched, Erelzi was £17 per injection. To me that was a small saving to risk my my health and well-being. All of this was put in my typed notes and I also added that I should have some say in what I inject into my body every week, theses are very powerful drugs.

I use the pre-filled syringes, my nurse advised me to do this because I was at the time injecting mtx, she added I would have more control over it going into my body if it stung. I have found it stings less if I inject into my tum and I always take it out of the fridge the day before injection day. Tomorrow is injection day and an injection is sitting in my cupboard as I type this. Sometimes it's stings, sometimes it doesn't, but that bit of discomfort for a few seconds is worth it. I'm afraid I don't agree with putting an injection into your bra to bring it up to body temperature, it's not suppose to go over 25 c.

I think we have to stand up for ourselves on occasions like this, I'm not saying go in with guns a blazing but armed with facts that they can't dispute. I've read on here many times that people have been told they are exactly the same drug...they aren't...they are similar...hence the name bio similar. I actually knew how they differed from enbrel in case I got challenged, but I wasn't. If he was doing well on enbrel try your hardest to get him back on it, many people have been put back on enbrel when the biosimilar drug didn't work so well.

bnf.nice.org.uk/drugs/etane...