Crohn's Disease Forum » General IBD Discussion » Inflectra vs Remicade?


01-31-2019, 02:52 PM   #1
NuttyGuts
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Inflectra vs Remicade?

Hi All,
Just had surgery in December to remove terminal ileum, ileocecal valve, appendix, and first bit of cecum. Surgeon says all looks good and time to get back on Remicade. When I called the hospital to schedule, they inform me that they are only doing Inflectra now. I had never even heard of Inflectra before, but looked it up and it appears to be a generic version of Remicade only a little cheaper, maybe by 15-20%. My insurance refused it, so the hospital will order the Remicade for me. I just have to wait until the order comes in. So has anyone tried Inflectra yet? My doc approved the change, it's the insurance that did not. And I have no idea why, since it supposedly is cheaper. I have mixed feelings about all this. Would love to have a less expensive alternative but worry that it won't be as effective. This will be my fourth infusion, so maybe I can't really judge effectiveness yet? Any info/shared experience would be most appreciated!
01-31-2019, 04:32 PM   #2
Scipio
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So has anyone tried Inflectra yet? My doc approved the change, it's the insurance that did not. And I have no idea why, since it supposedly is cheaper.
I suspect that the insurance company refused to cover it simply because it is not yet listed on their approved formulary, probably due to the bureaucratic wheels turning slowly. Once they officially realize that it will save them money they will probably not only allow it but will stubbornly insist upon it.
01-31-2019, 08:34 PM   #3
NuttyGuts
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Ah, that makes sense! I suppose by the time I go for the 5th infusion, they will have approved it. Remicade is infliximab, and Inflectra is infliximab-dyyb. I have no idea what the -dyyb means, but I sure hope it is just as effective. According to what I can find on the web, Inflectra is only 15-20% cheaper than Remicade, so not a great savings like other generics can be.
02-01-2019, 11:08 AM   #4
Scipio
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The "dyyb" is a meaningless suffix that the FDA adds to the names of biosimilar biologics to distinguish them from the original drug. Each biosimilar gets its own unique 4-letter suffix, and according to FDA rules the suffix must be meaningless.
02-01-2019, 11:14 AM   #5
NuttyGuts
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Hey, thanks for that info, Scipio! So is a biosimilar a generic drug? Is it just a special name because the drug (in this case, Inflectra) is a generic for a biologic (Remicade)?
02-01-2019, 12:28 PM   #6
Scipio
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A biosimilar is the equivalent of a generic drug for biologic drugs.

For traditional small molecule drugs a generic manufacturer has to prove to FDA that the generic is chemically identical to the original drug - right down to the location of every atom that makes up the molecule. That's impossible to do for biologics which are large, complex proteins consisting of hundreds or thousands of atoms. The exact position of every atom is not even known for the original drug, much less for the copy.

So the FDA invented this new category of drugs called biosimilar for which the generic drug maker must show that it is very similar chemically, if not exactly identical, and that it behaves the same in animals and humans as the original drug. So far most biosimilars appear to be working pretty well. But you know how it is with Crohn's - no two cases are exactly alike and no two drugs work exactly the same.
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