What is the difference between Lupron (leuprolide) and Eligard (leuprolide) in the treatment of hormone-sensitive conditions?

Lupron vs Eligard: Key Differences

Both Lupron and Eligard contain the identical active ingredient (leuprolide acetate) and achieve equivalent clinical outcomes, but they differ primarily in cost structure and delivery system—Eligard is substantially less expensive at GPO and 340B pricing while using a subcutaneous delivery system, whereas Lupron uses intramuscular injection and costs significantly more. 1

Cost Differences

The most striking difference between these two formulations is pricing:

• Eligard GPO pricing: $92.85 per dose (regardless of 7.5mg, 22.5mg, 30mg, or 45mg formulation) 1
• Lupron GPO pricing: $1,453.36-$1,453.38 per dose (across all formulations) 1
• 340B pricing: Eligard ranges from $69.40-$87.69 versus Lupron at $46.09-$104.10 1
• Medicare costs and 6-month total costs are identical at $1,235.22 for both medications across all dosing schedules 1

This represents approximately a 15-fold cost difference at GPO pricing, making Eligard substantially more cost-effective for healthcare systems and patients with high out-of-pocket costs. 1

Delivery System Differences

Route of administration:

• Lupron: Intramuscular (IM) injection 1
• Eligard: Subcutaneous (SC) injection 1, 2

Both formulations are available in identical dosing schedules:

• 7.5 mg every 4 weeks 1
• 22.5 mg every 12 weeks 1
• 30 mg every 16 weeks 1
• 45 mg every 24 weeks 1

Clinical Efficacy

Both formulations demonstrate equivalent clinical efficacy for androgen deprivation therapy in prostate cancer and ovarian suppression in hormone-sensitive conditions. 1, 2, 3

• A direct comparison study in transgender youth found that Eligard achieved biochemical suppression in 90% versus Lupron at 69% (p=0.06), though both achieved 100% clinical puberty suppression 2
• Pooled data from 1,906 patients treated with Eligard showed median PSA decline from 12.0 ng/mL to 0.5 ng/mL after 12 months, with adverse events in only 8.8% of patients 3
• Both formulations are considered equivalent to bilateral orchiectomy for prostate cancer treatment 1, 4

Practical Considerations

When to choose Eligard:

• When cost is a significant factor for the patient or healthcare system 1
• When subcutaneous administration is preferred (potentially less painful, can be self-administered with proper training) 2
• In routine clinical practice where both formulations have demonstrated equivalent outcomes 3

When formulation choice matters less:

• Medicare patients face identical out-of-pocket costs regardless of formulation choice 1
• Clinical outcomes for testosterone suppression are equivalent between formulations 1, 2, 3

Important Caveats

• Drug shortages: Lupron shortages have historically occurred, necessitating transitions to Eligard 2
• Monitoring requirements are identical: Both require monitoring of testosterone/estradiol levels, particularly in patients under 60 years or those transitioning between therapies 1
• Flare phenomenon: Both formulations cause initial testosterone surge requiring consideration of antiandrogen coverage in patients with high disease burden 1, 4
• Cardiovascular safety: Both GnRH agonists carry cardiovascular risks, though less than historical DES therapy 1

Clinical Decision Algorithm

1. Verify insurance coverage and pricing for both formulations at your institution 1
2. If cost differs significantly (as with GPO/340B pricing), choose Eligard unless contraindication exists 1
3. If Medicare patient, either formulation is equivalent from cost perspective 1
4. Consider patient preference regarding IM versus SC administration 2
5. Ensure appropriate monitoring regardless of formulation choice 1