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Enbrel vs. Trexall

Head-to-head comparisons of medication uses, side effects, warnings, and more.

Key takeaways

Enbrel (etanercept) and Trexall (methotrexate) are both used to treat rheumatoid arthritis (RA) and other autoimmune conditions, but they have some key differences. Enbrel is a biologic DMARD that you inject under the skin, while Trexall is an antimetabolite that you take by mouth. Enbrel works by blocking a protein called tumore necrosis factor (TNF) to reduce inflammation, whereas Trexall's exact mechanism for treating non-cancer conditions is not fully understood, though it is known to suppress the immune system. Enbrel is available as rand-name and biosimilar products, but it can be expensive. Trexall is available in generic form, making it more affordable. Enbrel is typically taken once a week, but Trexall's dosing can vary depending on the condition being treated. Both medications can increase your risk of infections, but Trexall also has a higher risk of causing liver damage and other serious side effects. Additionally, Enbrel is not recommended for people with a history of hepatitis B, while Trexall should be avoided during pregnancy for non-cancer conditions.

Enbrel

(etanercept)

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Methotrexate

(Trexall)

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Summary for Enbrel

Prescription only

Enbrel (etanercept) is a weekly injection used for many autoimmune conditions. Currently, it's only available as a brand-name product and can be expensive.

Indications for Enbrel

  • Rheumatoid arthritis (RA)
  • Plaque psoriasis (PsO) and psoriatic arthritis (PsA)
  • Ankylosing spondylitis (AS)
  • Childhood arthritis (polyarticular juvenile idiopathic arthritis, JIA)

Pros and Cons for Enbrel

Pros

  • Available in a prefilled syringe or autoinjector for easy-at-home injections
  • Can be used in children age 2 and older for certain indications (JIA)
  • Can be kept at room temperature for up to 14 days
  • Manufacturer offers copay card for people with commercial insurance
  • Not many side effects other than infection and redness and irritation at the injection site

Cons

  • Raises risk of serious infections
  • Can cause the hepatitis B virus to reappear if you have a history of infection
  • Lymphoma and other cancers have been reported in people taking Enbrel (etanercept)
  • Available only as a brand medication so it can be expensive and isn't always covered by insurance
  • Needs to be given every week, unlike Humira (adalimumab), which is given every other week

Common Side Effects for Enbrel

  • Infection (including common cold/flu) (50%)
  • Injection site reaction (37%)
  • Diarrhea (8%)

Warnings for Enbrel

  • Serious infections
  • Cancers
  • Nervous system effects
  • Heart failure
  • Bleeding and infections

Summary for Trexall

Prescription only

Methotrexate (Trexall) belongs to a drug class called antimetabolites. It’s used as chemotherapy at high doses to kill cancer cells and treat different cancers, such as acute lymphoblastic leukemia (ALL). At lower doses, methotrexate (Trexall) is considered a disease-modifying antirheumatic drug (DMARD) that treats certain non-cancer conditions, such as rheumatoid arthritis (RA). This medication is a tablet that you take by mouth. For most conditions, it’s taken once a week, but for some, it’s taken more often than that. Methotrexate (Trexall) side effects include mouth sores, nausea, and stomach upset.

Indications for Trexall

Cancer:

Non-cancer conditions:

Pros and Cons for Trexall

Pros

  • Taken by mouth, so a good option for people who don’t like needles
  • A non-steroidal option for autoimmune conditions (e.g., rheumatoid arthritis, psoriasis)
  • Doesn’t typically cause hair loss or weight gain

Cons

  • Might cause nausea and mouth sores
  • Can raise your risk for infection
  • Requires regular office visits and lab tests to check for serious side effects

Common Side Effects for Trexall

  • Mouth sores
  • Nausea or vomiting
  • Diarrhea
  • Stomach upset
  • Dizziness
  • Tiredness
  • Chills
  • Fever
  • Infection
  • Higher liver enzyme levels in the blood
  • Low white blood cells
  • Low platelet levels

Warnings for Trexall

  • Harm to unborn baby
  • Allergic reaction
  • Low blood cell counts
  • Damage to the digestive tract
  • Liver damage
  • Lung problems
  • Serious skin problems (including skin burns)
  • Kidney damage
  • Risk of serious side effects with dosing errors
  • Effect on folic acid levels in the body
  • Serious infections
  • Serious nervous system problems
  • Risk for new cancers
  • Tumor lysis syndrome
  • Changes to your ability to have children (infertility)
  • Higher risk for side effects if you have extra body fluid

Prices with our coupons for Enbrel vs. Trexall

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Enbrel1 carton / 4 sureclicks of 50mg
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Trexall4 tablets / 10mg
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