Rituximab Vs Infliximab (Rituxan Vs Remicade) – Comparison

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rituximab vs infliximab rituxan vs remicade

Rituximab Vs Infliximab is a comparison of the two drugs. Rituximab is a monoclonal antibody that targets CD-20 Positive B Lymphocytes While Infliximab is a TNF Inhibitor.

Drug Description: Rituximab Vs Infliximab:

Rituximab

Infliximab

Class Monoclonal type I CD20 antibody
  • Tumor necrosis factor (TNF-alpha or TNF-α) blocker
  • Chimeric Monoclonal IgG1 antibody
Trade Names
  • MabThera,
  • Rixathon,
  • Ruxience, and
  • Truxima
  • Avsola,
  • Flixabi,
  • Inflectra,
  • Remicade,
  • Renflexis
Formula C6416H9874N1688O1987S44 C6428H9912N1694O1987S46
Molar mass 143860.04 g·mol−1 144190.64 g·mol−1

Mechanism of Action of Rituximab Vs Infliximab:

Rituximab

Infliximab

Rituximab is a monoclonal antibody against the CD20 antigen on the B cell’s surface. It induces complement-mediated cytotoxicity and antibody-dependent cell-mediated cytotoxicity after binding to the CD 20 surface antigen. It invokes structural changes, apoptosis, and sensitization of cancer cells to chemotherapy. Infliximab is an IgG1κ monoclonal antibody that binds to the transmembrane forms of TNF-α thus disrupting the pro-inflammatory cascade signaling. It results in the reduction of pro-inflammatory cytokines such as IL-1, IL-6, lymphocytes, endothelial adhesion molecules, and acute-phase proteins. Infliximab inhibits TNF-α in endothelial cells, human fibroblasts, neutrophils, and B and T lymphocytes.

Rituximab Vs Infliximab: Pharmacokinetics, Dose, and Indications:

Rituximab

Infliximab

Distribution
  • Vd: 3.1 L (RA)
  • Vd: 4.5L (GPA and MPA)
  • Vd: 3-6 L
Half-life elimination 5 – 78 days 7.7-9.5 days
Administration and Dosage
  • Administer Only as an Intravenous Infusion.
  • Do not administer as an intravenous push or bolus.
  • 100 mg/10 mL and 500 mg/50 mL solution in a single-use vial
  • Dilute Infliximab solution dose of 250mL in 0.9% NaCl by withdrawing the same volume of 250mL from the Normal Saline drip.
  • Never dilute the infliximab solution in any diluent other than normal 0.9% NaCl.
  • Infuse it over ≥2 hours
Indications
  • Non-Hodgkin’s Lymphoma (NHL)
  • Chronic Lymphocytic Leukemia (CLL)
  • Rheumatoid Arthritis (RA) in combination with methotrexate in adult
  • Granulomatosis with Polyangiitis (GPA) (Wegener’s Granulomatosis)
  • Microscopic Polyangiitis (MPA) in adult patients in combination with glucocorticoids
  • Crohn’s Disease
  • Rheumatoid Arthritis
  • Psoriatic Arthritis
  • Plaque Psoriasis
  • Ulcerative Colitis
  • Ankylosing Spondylitis
  • Idiopathic Pulmonary Fibrosis (Orphan)
Use in Pregnancy
  • Based on the studies conducted on pregnant female animals. It causes B-cell Lymphocytopenia in infants exposed to the drug in-utero.
  • Thus, this drug is contraindicated in a pregnant patient.
  • The pregnant female taking infliximab showed an increased risk of preterm delivery, low birth weight, and small for gestational age at birth
  • However, more adverse pregnancy outcomes were seen in the women having active IBD and RA.
  • Therefore, Infliximab can be administered with caution to the pregnant female if her disease is active at any duration of pregnancy.

Common Side effects: Rituximab Vs Infliximab:

Rituximab

Infliximab

Side effects
  • Angioedema
  • Asthenia
  • Skin Rashes
  • Pruritis
  • Myalgia
  • Arthralgia
  • Anemia
  • Peripheral Edema
  • Insomnia
  • Infusion Reactions
  • Depression
  • Herpes Simplex
  • Alopecia
  • Development of antinuclear antibodies
  • Infection
  • Nausea
  • Infusion-related reaction
  • Headache
  • Development of antibodies to double-stranded DNA
  • Other respiratory infections (eg, sinusitis, cough)
  • Diarrhea
  • Bronchitis
  • Dyspepsia
  • Rash
  • Elevated ALT, ≥3 ULN
  • Fatigue
  • Back pain
  • Rhinitis
  • Urinary tract infection
  • Arthralgia
  • Fever
  • Hypertension
  • Pruritus
  • Dyspnea
  • Candidiasis
  • Lupus-like symptoms
  • Elevated ALT, ≥5 ULN

Contraindications and Warnings: Rituximab Vs Infliximab:

Rituximab:

It should be used with caution in the following conditions:

  • Bowel obstruction or perforation
  • Ventricular fibrillation
  • Myocardial infarction
  • Cardiogenic shock.
  • Patients should be screened for Hepatitis B prior to therapy. Screening should include HBsAg (hepatitis B surface antigen) and Hepatitis B core antibody (anti-HBc). All patients who develop viral hepatitis should be treated with appropriate antiviral therapy.

Infliximab:

  • If the patient is older than 65 years, there is an increased risk of developing infections or sepsis
  • The patients who were treated with this drug in childhood or adolescence reported to have developed lymphomas or other malignancies at later age.
  • There is an increased risk of infections caused by opportunistic pathogens such as Legionella, Listeria, Mycobacterium tuberculosis), and hepatitis B virus in the subject taking infliximab.

Rituximab Vs Infliximab in Remission of refractory hepatitis C:

  • The patients with HCV with severe multisystem disease showed partial disease control with Rituximab
  • But with subsequent Infliximab therapy showed full remission in patients with refractory Hepatitis C
  • HCV positive patients with renal involvement who responded to the Rituximab therapy showed a better clinical response. And such cases were reported when the patient became normotensive with the return of normal renal function.
  • Infliximab is effective in controlling Gastrointestinal Vasculitis. And such patients had decreased risk of GIT bleeding as compared to the patients taking Rituximab
  • However, Rituximab is more effective in controlling the cutaneous and renal manifestations in patients with chronic Hepatitis C.

Infliximab better controls GI Vasculitis While Rituximab controls Renal and Cutaneous Vasculitis well

Rituximab Vs Infliximab role in Rheumatoid Arthritis:

  • Rheumatoid Arthritis is a chronic multi-system autoimmune disease of unknown etiology. It mainly affects the synovial joints which eventually causes the cartilaginous and bony elements destruction resulting in chronic pain and disability
  • A RCT was conducted to see the efficacy of Rituximab and Infliximab in patients showing no clinical improvements with DMARDS i.e. methotrexate
  • In rheumatoid arthritis, RCTs suggested that Rituximab provides more adequate control of disease than DMARDs such as methotrexate.
  • The patients who showed inadequate response with the Rituximab showed better response with the infliximab-based therapy.
  • However, the main drawback of infliximab is its cost-effectiveness and magnitude of side effects.
  • The patients taking rituximab showed a lack of compliance because of its intolerance and ineffectiveness.

Rituximab is well tolerated and has better compliance than infliximab, however, Infliximab is better at controlling the disease

Rituximab Vs Infliximab role in Refractory Wegner’s Granulomatosis:

  • Wegener’s Granulomatosis is ANCA-associated vasculitis with systemic involvement.
  • The patients taking Rituximab showed a better response, maintaining remission and compliance with this drug.
  • In terms of Wegner’s Granulomatosis severity before the start of treatment, the drug tolerance is similar in patients taking Rituximab and Infliximab.
  • The infliximab-taking patient showed a greater relapse and death rate than the group taking Rituximab.
  • In conclusion, Rituximab showed superior results in patients having refractory Wegener’s Granulomatosis.

Rituximab is Superior to infliximab in GPA

Rituximab Vs Infliximab role in Crohn’s Disease:

  • In patients with active Crohn’s disease, who were found to be resistant to standard therapy showed induction and maintenance of remission with Infliximab.
  • However, there is an increased risk of loss of efficacy, infusion allergic reaction, and infections due to the development of antibodies against this drug.
  • Rituximab administration in Crohn’s Disease led to a drastic decrease in B cells and it was well tolerated by patients. But it failed to induce long-term remission in moderately active UC.

In IBDs, Infliximab is superior to Rituximab

Conclusion:

The Randomized controlled trials have evaluated the efficacy of the two drugs used in different autoimmune diseases. Infliximab has shown far more superior results in patients with Crohn’s disease than Rituximab in inducing and maintaining remission. However, in vasculitis and Rheumatoid arthritis, Rituximab is superior and has better compliance than Infliximab.

More studies need to be conducted to make either of the drugs standard therapy in different diseases.

Read: Rituximab VS Obinutuzumab (Rituxan Vs Gazyva) Comparison