Enbrel vs. Remicade: What You Should Know


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Introduction

If you have a certain kind of autoimmune disease, Embrel (etanercept) and Remicade (infliximab) may be treatment options for you. Autoimmune diseases result from your immune system attacking your own body.

Enbrel and Remicade are biologic drugs available by prescription only. Biologics are made using living cells. Both Enbrel and Remicade have biosimilars. But only some are available in the United States. Biosimilar drugs are similar to their brand-name counterparts but tend to cost less.

If you’re deciding between Enbrel and Remicade for your condition, it helps to know how these drugs are alike and different. Keep reading to find out.

Note: For more information about these drugs, see these in-depth Enbrel and Remicade articles.

What are the ingredients in Enbrel and Remicade?

Enbrel contains etanercept as its active ingredient.

Remicade contains infliximab as its active ingredient.

Both Enbrel and Remicade are part of a drug class called tumor necrosis factor (TNF) blockers. TNF is linked to inflammation. By blocking TNF, these medications can help reduce inflammation and ease symptoms.

What are Enbrel and Remicade used for?

Enbrel and Remicade are prescription medications used to treat certain autoimmune diseases. Your doctor may prescribe either of these drugs if you’re an adult and you have one of the following conditions:

  • rheumatoid arthritis (RA), an autoimmune disease that affects your joints
  • psoriatic arthritis, a kind of arthritis that can develop from psoriasis
  • ankylosing spondylitis, a kind of arthritis that affects your spine
  • plaque psoriasis, an autoimmune disease that results in plaques (scaly patches) forming on your skin

In addition, Enbrel is also used to treat:

  • polyarticular juvenile idiopathic arthritis in children ages 2 years and older
  • plaque psoriasis in children ages 4 years and older

Remicade is also used to treat the following types of inflammatory bowel disease in adults and children ages 6 years and older:

  • Crohn’s disease
  • ulcerative colitis

Note: For more details about the use of these medications, see these in-depth Enbrel and Remicade articles.

What are the dosages and forms of Enbrel and Remicade?

Enbrel and Remicade differ in how they’re given. Enbrel comes in several forms, while Remicade comes in only one form.

Enbrel is given as an injection under your skin, usually once or twice every week. If Enbrel becomes part of your treatment plan, your healthcare provider will teach you how to use it. Then you can give yourself Enbrel at home.

Enbrel is available in the following forms:

  • prefilled syringes
  • prefilled SureClick autoinjector
  • Enbrel Mini prefilled cartridge (to be used in a reusable AutoTouch autoinjector)
  • vial of powder (to be mixed into a solution before injection with a syringe)
  • vial of solution (to be drawn up and injected with a syringe)

Remicade is given as an infusion, usually once every 4 to 8 weeks. With an infusion, medication is dripped into your vein over a period of time. A Remicade infusion takes about 2 hours.

If you start treatment with Remicade, you’ll receive your infusions from a healthcare provider at a doctor’s office or hospital.

Remicade is available in just one form: a vial of powder. A healthcare provider will mix the powder with sterile water as part of the preparation for your infusion.

For both Enbrel and Remicade, your dosage will depend on your condition. Talk with your doctor to discuss the dosage that may work best for your treatment plan.

Cost may be a factor when you’re considering adding Enbrel or Remicade to your treatment plan.

To see estimates of what Enbrel and Remicade may cost, visit GoodRx.com. But keep in mind that what you’ll pay for either drug depends on your treatment plan, your health insurance, and the pharmacy you use.

Enbrel and Remicade are both biologic medications. A biologic is made from parts of living organisms. So it’s not possible to copy biologic drugs exactly.

Enbrel and Remicade both have biosimilar forms, some of which currently aren’t available on the U.S. market.

Biosimilars are like generic drugs. But unlike generics, which are made for non-biologic drugs, biosimilars are made for biologic drugs. A biosimilar tends to cost less than its “parent” drug.

If you’re interested in using a biosimilar form of Enbrel or Remicade, talk with your doctor about which ones are available.

What are the side effects of Enbrel and Remicade?

Enbrel and Remicade are both meant to be long-term treatments. So you may be wondering what their possible side effects are. Both drugs can cause mild or serious side effects.

Enbrel and Remicade work in a similar way, so they can cause many of the same side effects. But there are also some that are different.

For more information about possible side effects, see these in-depth Enbrel and Remicade articles.

Mild side effects

Enbrel and Remicade may cause mild side effects in some people. The chart below lists examples of mild side effects that can occur with these drugs.

Enbrel Remicade
Itchy skin X
Fatigue (lack of energy) X
Headache X
Abdominal (belly) pain X
Injection or infusion site reactions X X
Respiratory infections X X
Diarrhea X X
Rash X X
Fever X X

This chart may not include all mild side effects of these drugs.

For more information on mild side effects of the two drugs, see Enbrel’s medication guide and Remicade’s medication guide.

Serious side effects

In addition to the mild side effects described above, serious side effects may occur in people using Enbrel or Remicade. See the chart below for a list of possible serious side effects.

Enbrel Remicade
Leukemia X
Hypoglycemia (low blood sugar) X
Severe liver damage X
Stroke X
Heart attack X
Serious infections* X X
Certain types of cancer, such as lymphoma or skin cancer* X X
Congestive heart failure X X
Nervous system problems, such as multiple sclerosis, optic neuritis, or seizures X X
Decreased blood cell levels X X
Hepatitis B reactivation X X
Lupus-like syndrome X X
Severe allergic reaction X X

* Enbrel and Remicade both have boxed warnings for this side effect. A boxed warning is the most serious warning from the Food and Drug Administration (FDA). It alerts doctors and patients about drug effects that may be harmful. To learn more, see the “What are the warnings of Enbrel and Remicade?” section below.

To learn more details about the serious side effects above, see these in-depth Enbrel and Remicade articles.

If you’re concerned about your risk for serious side effects with either Enbrel or Remicade, talk with your doctor.

How effective are Enbrel and Remicade?

You may wonder whether Enbrel or Remicade is effective at treating your condition.

Studies have found both Enbrel and Remicade to be effective at treating various autoimmune conditions. If you’d like to read more about how each drug performed in studies, see the prescribing information for Enbrel and Remicade.

What are the warnings of Enbrel and Remicade?

Enbrel or Remicade may not be right for you if you have certain medical conditions or other factors that affect your health. Talk with your doctor about your health history before you take either drug.

Boxed warnings: Infections and cancer

Both Enbrel and Remicade have boxed warnings for the risk of infections and cancer. A boxed warning is the most serious warning from the Food and Drug Administration (FDA). It alerts doctors and patients about drug effects that may be dangerous.

Infections. Enbrel and Remicade can increase your risk for serious infections, such as tuberculosis (TB). These infections may result in a hospital stay or even death.

Serious infections were more common in people who were taking Remicade or Enbrel with other drugs that affect the immune system.

Before you start treatment, tell your doctor if you have any current infections or have had any recently. This includes minor infections, such as a cold. During your treatment, let your doctor know right away if you have any signs of an infection, such as a fever or common cold symptoms.

Cancers. In rare cases, certain kinds of skin cancer, lymphoma, and other cancers have been reported in people who took Enbrel or Remicade. Most cases were seen in children and adolescents.

Your doctor will regularly screen you for cancer during and after treatment with either of these drugs.

Other warnings

In addition to the boxed warnings, Enbrel and Remicade have other warnings.

Before taking Enbrel or Remicade, talk with your doctor if you have any of the following conditions or health factors.

  • Warnings for both Enbrel and Remicade:

    • hepatitis B reactivation
    • liver disease or alcoholic hepatitis
    • heart failure
    • nervous system problems, such as optic neuritis (an eye condition)
    • allergic reaction
    • pregnancy
    • breastfeeding
  • Warnings for Enbrel:

    • diabetes
  • Warnings for Remicade:

    • serious infusion reactions

For more information about these warnings, see these in-depth Enbrel and Remicade articles.

Can I switch between Enbrel and Remicade?

The short answer: It’s possible.

Details: While Enbrel and Remicade both work in a similar way, they stay in your body for different lengths of time.

It could be harmful to have both of these drugs in your system at the same time. This would raise your risk for serious side effects, especially severe infections.

If your doctor wants you to switch from Remicade to Enbrel, or vice versa, they’ll guide you on the timing. It’s important to wait until one drug is out of your system before switching to the other.

Reminder: You shouldn’t switch drugs or stop your current treatment unless your doctor tells you it’s OK.

What should I ask my doctor?

Enbrel and Remicade work in a similar way, but they’re different in many ways. They have some of the same side effects, but also some different ones. They treat several of the same conditions.

One of the main differences is how you’ll experience receiving your treatment. Enbrel can be self-injected at home, usually once or twice a week. Remicade must be given as an intravenous (IV) infusion at your doctor’s office or hospital, usually every 4 to 8 weeks.

If you have questions about the best treatment plan for your condition, talk with your doctor. Some questions that might be helpful to ask your doctor include:

  • Is there a reason why Enbrel might be better for my condition than Remicade?
  • Would Enbrel or Remicade interact with any other medications I’m taking?
  • Would Enbrel or Remicade be better for me based on my health history?
  • What would happen if I missed my Remicade appointment due to being ill, traveling, etc.?

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Ask a pharmacist

Q:

Is it safe for me to get vaccines, such as an annual flu shot, while taking Enbrel or Remicade?

Anonymous patient

A:

Some vaccines are safe, but you should avoid live vaccines while taking Enbrel or Remicade.

Live vaccines contain weakened versions of viruses or bacteria. This helps your body recognize these viruses or bacteria as threats to avoid future infections.

But Enbrel and Remicade work by weakening your immune system, which increases your risk for infections. Live vaccines may cause actual infection in people with weakened immune systems.

Examples of live vaccines include:

  • measles, mumps, rubella (MMR)
  • chickenpox
  • shingles
  • nasal spray form of flu vaccine

If you’re taking Enbrel or Remicade, talk with your doctor before scheduling any vaccinations. They’ll determine whether the vaccine is safe or if you should stop treatment to be vaccinated.

Victor Nguyen, PharmD, MBAAnswers represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.

Healthline

Disclaimer: Healthline has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or other healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.


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