I tried ENBREL, HUMIRA, and I'm currently on CIMZIA.
ENBREL hurts the least. The lyophilized vials are even less painful than the prefilled syringes, but I don't recommend them because the boxes are huge and take up a lot of fridge space. I don't even know if the vials are still available.
ENBREL was my first anti-TNF and --I kid you not-- I woke up in remission the next morning after my first dose. I mean, I got out of bed, took a shower, went to shave and suddenly realized that I wasn't leaning on the sink like I usually did. And then I took a quick stock and realized that for the first time since age 16, nothing in my body hurt. That's when I literally started jumping for joy...because I could jump.
Of course when I started it in 2004, lyophilized vials that you had to reconstitute were the only form available and the dosing was twice weekly. Then they made it so that you could inject two shots once a week. Finally, the prefilled syringes came out.
It's mechanism of action is a bit different than the other anti-TNFs. With etanercept, two soluble TNF receptors are fused together using the very butt end of the IgG1 molecule. These fused TNF receptors have a markedly higher affinity for TNF-a than single soluble receptor, but they do not bind permanently to TNF, rather having a high on/off rate. Antibodies bind permanently. Whether this is relevant is a subject of some debate.
More importantly, REMICADE (infliximab) is a chimeric monoclonal antibody. About 1/4 of the antibody comes from a mouse and this raises the possibility of allergic reactions to it or the formation of neutralizing antibodies against the mouse regions of the molecule. You also have to go in every time for the infusion, which can be very inconvenient.
Also, as far as affinity for the TNF molecule, the order is that adalimumab is the least, infliximab in the middle, and golimumab and etanercept the highest.
If it were up to me, I'd try the ENBREL first and then REMICADE if you want. But if you fail that, then the good news is that there are other options in the pipeline. Secukinumab (COSENTYX) will get approval in 3-6 months, probably, and ustekinumab (STELARA) is already approved, although not for AS just yet.
