Kevzara and prednisone effectivness

@dadcue oops. Thanks for the date corrections. I didn’t edit very well. Thank you for catching it.
Yes, Actemra was FDA approved in 2017, for GCA.
And Kevzara was approved in 2023, for PMR. The Kevzara-GCA trial was terminated before completion.

I’ve wondered many times, if Acetimra would be more effective for me. I’m just in the dark about what the switching process would entail (half-life’s, pause time, would I need to resume or restart prednisone for a period of time, etc.)

Possibly switching biologics is what started my interest in Cosentix. If I switch, which should I switch to, Actemra or Cosentix, and would I have to wait for Cosentix to be FDA approved to obtain it for PMR, and would my insurance cover either. These are questions for my rheumatologist at my Sept. appointment.

@dadcue oops. Thanks for the date corrections. I didn’t edit very well. Thank you for catching it.
Yes, Actemra was FDA approved in 2017, for GCA.
And Kevzara was approved in 2023, for PMR. The Kevzara-GCA trial was terminated before completion.

I’ve wondered many times, if Acetimra would be more effective for me. I’m just in the dark about what the switching process would entail (half-life’s, pause time, would I need to resume or restart prednisone for a period of time, etc.)

Possibly switching biologics is what started my interest in Cosentix. If I switch, which should I switch to, Actemra or Cosentix, and would I have to wait for Cosentix to be FDA approved to obtain it for PMR, and would my insurance cover either. These are questions for my rheumatologist at my Sept. appointment.

@stonewheel I think your insurance would not allow anything not approved. I asked about actemra, but my rheumatologist said medicare would say no. But she also talked about rinvoq, and that's not approved, so who really knows.

@stonewheel

I don't think there is a significant difference between Kevzara and Actemra. The Actemra biosimilars probably work well too. I stay on Actemra because that was what I started with and it continues to work for me. I have switched from Actemra injections every 2 weeks and increased to weekly injections. I now do a monthly infusion of Actemra and that has some advantages that I like. My rheumatologist doesn't mind if I do the infusion one week early which I rarely do. When my schedule doesn't allow for an infusion exactly at every 4 weeks, I do it at 5 or 6 weeks. I have gone as long as 7 weeks between infusions but that is a little too long . I don't have a full blown flare but my pain increases a little bit and my inflammation markers become slightly elevated.

I transitioned from Actemra to Humira and back to Actemra without any problems. There weren't any gaps in treatment. When it was time for my next dose of Actemra, I did a dose of Humira instead. It was the same when I switched from Actemra injections to a monthly infusion. When it was time for my next injection, I did an infusion instead.

The nice thing about an infusion is that it is weight adjusted and can be given in any dose. My infusion dose has been adjusted by the doctor a few times. My rheumatologist asks me if the current dose is good for the whole month and he can adjust my dose up or down accordingly. Nothing changes too much so I get the same dose most of the time. The dose of an Actemra infusion can be either 4 mg per kg but can be as high as 8 mg per kg of body weight. I currently do 600 mg every 4 weeks.

Doses exceeding 600 mg per infusion are not recommended in GCA patients. I have PMR but I'm treated "as if" I have GCA.
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https://www.drugs.com/dosage/actemra.html
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"The recommended dosage of ACTEMRA for adult patients given as a 60-minute single intravenous drip infusion is 4 mg per kg every 4 weeks followed by an increase to 8 mg per kg every 4 weeks based on clinical response.

Reduction of dose from 8 mg per kg to 4 mg per kg is recommended for management of certain dose-related laboratory changes including elevated liver enzymes, neutropenia, and thrombocytopenia."

@dadcue the molecular structure is different and built not the same, forgive my lack of understanding.
Actemra is:
C₆₄₂₈H₉₉₇₆N₁₇₂₀O₂₀₁₈S₄₂
Kevzara is structured (my guess is, composed) differently and not listed molecularly that I could find. They both may have many of the same atoms/elements in common but not precisely and may be entirely derived drugs. That’s all I can come up with. Kevzara might be a bit more secretive with regards to propriety.

They both inhibit IL-6, and both end in “umab” in their generic names.

Any help is appreciated.

@dadcue the molecular structure is different and built not the same, forgive my lack of understanding.
Actemra is:
C₆₄₂₈H₉₉₇₆N₁₇₂₀O₂₀₁₈S₄₂
Kevzara is structured (my guess is, composed) differently and not listed molecularly that I could find. They both may have many of the same atoms/elements in common but not precisely and may be entirely derived drugs. That’s all I can come up with. Kevzara might be a bit more secretive with regards to propriety.

They both inhibit IL-6, and both end in “umab” in their generic names.

Any help is appreciated.

@stonewheel This isn't exactly what you're asking about, but it's something I've been interested in since I started taking Actemra over 2 years ago. I kept seeing commercials for drugs on tv, and the drugs would have "mab" as part of their name. It made me wonder if there is a convention for the names, so I researched that.

Actemra is a version of tocilizumab, and Kevzara is a version of sarilumab. The "mab" stands for monoclonal antibodies. The "toc" and "sar" are arbitrary prefixes. The "il" means the target system for the drugs in the body is immunomodulators. I take that to mean they modify the immune system. The "u" in sarilumab means the original antibodies used for the drug came from humans. The "zu" in tocilizumab means the original antibodies were humanized from animal antibodies. For tocilizumab, the animal was a mouse.
I would provide a link, but it's pretty confusing. The naming convention has been revised several times. You can get more information by searching for naming convention for monoclonal antibodies.

This is an aside, but I think it's interesting. During the Covid epidemic in 2020 I remember hearing on the news about monoclonal antibodies being used to treat difficult cases. They were actually talking about Actemra. I didn't get diagnosed until 2024, so I didn't know anything about Actemra or monoclonal antibodies back in 2020.

@stonewheel This isn't exactly what you're asking about, but it's something I've been interested in since I started taking Actemra over 2 years ago. I kept seeing commercials for drugs on tv, and the drugs would have "mab" as part of their name. It made me wonder if there is a convention for the names, so I researched that.

Actemra is a version of tocilizumab, and Kevzara is a version of sarilumab. The "mab" stands for monoclonal antibodies. The "toc" and "sar" are arbitrary prefixes. The "il" means the target system for the drugs in the body is immunomodulators. I take that to mean they modify the immune system. The "u" in sarilumab means the original antibodies used for the drug came from humans. The "zu" in tocilizumab means the original antibodies were humanized from animal antibodies. For tocilizumab, the animal was a mouse.
I would provide a link, but it's pretty confusing. The naming convention has been revised several times. You can get more information by searching for naming convention for monoclonal antibodies.

This is an aside, but I think it's interesting. During the Covid epidemic in 2020 I remember hearing on the news about monoclonal antibodies being used to treat difficult cases. They were actually talking about Actemra. I didn't get diagnosed until 2024, so I didn't know anything about Actemra or monoclonal antibodies back in 2020.

@jeff97

I was started on Actemra in 2019 and I had to abruptly discontinue Actemra because all supplies were being diverted to seriously ill Covid patients. I didn't mind because I was happy Actemra helped some people with Covid. My rheumatologist was so apologetic that I had to stop Actemra and she said that I needed something. Because of the lack of alternatives, Humira was restarted even though it didn't work so well the first time it was tried.

Covid 2020 was a bad year for me but not because I had a Covid infection. It took more than 6 months before supplies of Actemra improved. When Actemra was "interupted" --- Humira was started and I ended up being stuck on 20 mg of prednisone again. My rheumatologist couldn't believe how much I deteriorated. She said I didn't look good when she first saw me after face-to-face visits were allowed again.

@stonewheel

I don't know how the molecular structure compares. I only know that Actemra and Kevzara are in the same classification of medications. They are both IL-6 antagonists or IL-6 inhibitors.

Actemra was developed first and FDA approved for RA in 2009. Actemra was the first interleukin-6 (IL-6) receptor antagonist. It was derived from mouse proteins which didn't sound too good to me when I first heard that.

Kevzara was developed later and was the second IL-6 inhibitor. It was FDA approved for RA in 2017. I think Kevzara is made from human proteins.

Both Actemra and Kevzara have difficulty competing in the RA market because there are other biologics--especially TNF-inhibitors. Timing is everything when medications are developed. "The market" is also an important consideration. The RA market gets a lot of attention. The PMR/GCA market almost no attention until now. TNF-inhibitors don't seem to work well for PMR so the door was open for IL-6 inhibitors.

This is why Rinvog and Cosentyx will be interesting for people with PMR/GCA. We need more alternatives to prednisone. I'm happy prednisone isn't the "only option" anymore.