Simponi vs Remicade is a comparison between two drugs Simponi (Golimumab) and Remicade (Infliximab). Both of them are TNF (Tumor Necrosis Factor) Inhibitors. These drugs aid in the treatment of chronic inflammation in various conditions. This comparison is based on the mechanism of action, pharmacokinetics, and efficacy in different conditions.
Indications and Uses: Simponi vs Remicade:
These are indicated in the following disease conditions:
Simponi (Golimumab) | Remicade (Infliximab) |
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Simponi VS Remicade Pharmacokinetics:
Mechanism | Simponi | Remicade |
| Bioavailability | 53% | 92% |
| Half-life | 2 weeks | 7.7-9.5 days |
| Absorption | Achieves a maximum concentration after 2-6 days of subcutaneous administration | Achieves maximum concentration within 24 hours of intravenous administration |
| Clearance | 4.9-6.7Ml/day/kg after 1 dose | 11-15 mL/hour or 0.18-0.25 mL/minute. |
Mechanism of action of Simponi and Remicade:
Simponi (Golimumab):
Golimumab (Simponi) is a human monoclonal antibody, it binds to transmembrane TNF-α and inhibits its secretion. In this way, it prevents the binding of TNF-α to its receptors. This ultimately stops leukocyte infiltration by inhibiting E-selectins, ICAM-1 and VCAM-1.
It also inhibits InterLeukin-6 and InterLeukin-8 that are pro-inflammatory cytokines. This aids in preventing inflammation in chronic inflammatory conditions.
Remicade (Infliximab):
Infliximab (Remicade) is a monoclonal antibody. It binds to TNF-α with great affinity and disrupts the signaling of the pro-inflammatory cascade. This binding of TNF-α with antibodies prevents its binding to the cell surface receptors.
The actions of TNF-α are blocked which leads to decreased IL-6 and IL-1, reduced migration of leukocytes and lymphocytes to the site of inflammation. Infliximab also reduces the production of degrading enzymes synthesized by chondrocytes.
Simponi vs Remicade in pregnancy and lactation
Remicade:
- Infliximab is included in B category drugs in pregnancy. Limited data is available on whether Remicade can cause any fetal harm when administered during pregnancy or whether it affects fertility. Remicade should be administered in pregnant women only if it is needed. As other IgG antibodies, Remicade is also present in the serum of infants for up to 6 months. Live vaccination in such infants should be done with caution.
- It is not known whether Remicade is excreted in human milk, but because of the risk of adverse reactions in breastfed infants, women should not breast-feed while taking infliximab
Simponi:
- Golimumab is also ranked under category B. No adverse effects have been reported but the number of trials conducted on the use of golimumab during pregnancy is low. A greater risk of side effects is associated with exposure to golimumab in utero.
- The secretion of golimumab in breast milk is not known yet. In one clinical trial a woman undergoing golimumab therapy breastfed an infant, the study concluded that no differences were observed in the growth or development of that infant from any other infant.
Read: Rituximab Vs Infliximab (Rituxan Vs Remicade)
Simponi vs Remicade efficacy in different conditions:
Simponi Vs Remicade in Rheumatoid arthritis:
- Infliximab (Remicade) is approved by FDA for use in rheumatoid arthritis. Infliximab is in use for several years and many clinical trials have been conducted upon its efficacy in rheumatoid arthritis. It is proved to reduce swollen joints, pain and decrease physical inactivity in patients with rheumatoid arthritis to a greater extent.
- It reduces signs and symptoms of RA by downregulation of cytokine network, regulation of cell recruitment, prevents cartilage catabolism and bone erosion. Infliximab in combination with methotrexate is more efficacious in treating rheumatoid arthritis than monotherapy with either methotrexate or infliximab. [Ref]
In one clinical trial, Long-term use of infliximab developed Human Anti-chimeric Antibodies (HACA’s) limiting long-term use of infliximab in the treatment of RA, but further research is still needed in this regard. [Ref]
- Golimumab (Simponi) is one of the latest TNF-α inhibitors approved by the FDA. Golimumab being new has lesser comparison and clinical experience than the old TNF inhibitors. But various clinical trials confirmed the efficacy and safety of Golimumab in the treatment of RA. It is an attractive choice of treatment due to low levels of immunogenicity.
- Lower rate of drug discontinuation, low risk of production of antibodies, a convenient dosage scheme, and lesser incidence of injection site reactions. High doses are associated with side effects that’s why they must be administered with caution especially in obese patients. [Ref]
Simponi Vs Remicade in Ankylosing spondylitis
- Infliximab (Remicade) is effective in the treatment of active ankylosing spondylitis. It is generally well tolerated. A dosage of 5mg/kg at weeks 0, 2, and 6 is given for treating AS.
- In patients with ankylosis spondylitis, golimumab therapy is effective in reducing signs and symptoms with reduced back pain and inflammation. 50 and 100mg injections are administered every 4 weeks for the treatment of AS.
- It has a more convenient dosing schedule. Golimumab patients have a reduced sleep disturbance and overall fatigue symptoms associated with the treatment of ankylosing spondylitis. [Ref]
- In a clinical trial, patients maintained on infliximab and golimumab were studies, both TNF inhibitors were equally effective in decreasing disease progression and improving overall function. However, Infliximab was used greatly due to its high availability.
- The incidence of adverse effects of both drugs was also similar but there were some notable differences such as greater incidence of chest discomfort, fatigue, headaches, pain in extremities, and pruritus in patients using infliximab. [Ref]
Simponi Vs Remicade in Psoriatic arthritis
- Golimumab is effective in both peripheral and axial forms of psoriatic arthritis. It is approved for IV administration in PsA patients. Golimumab therapy in PsA patients is marked with slow progression of the disease and effective treatment of Enthesitis and nail disease however, dactylitis is improved with a 100mg dose of golimumab.[Ref]
- Infliximab is a chimeric monoclonal antibody against Tumor necrotic factor with a demonstrated efficacy in treating psoriatic arthritis. Infliximab significantly improves the quality of life, inhibits progression, causes improvement in nail disease, dactylitis, and enthesitis. Infliximab is marked superior to other conventional treatments. [Ref]
Read: Biologics for Psoriasis (TNF, IL-23, IL-39, IL-17, and CD-6 Inhibitors)
Simponi Vs Remicade in Ulcerative colitis:
Both infliximab and golimumab can be used in treating moderate to severe ulcerative colitis. There is limited data available on the comparative efficacy of the two drugs due to the lack of head-to-head trials. Several key observations in various studies suggest that infliximab is superior to golimumab in treating ulcerative colitis.
Infliximab has a rapid onset of action, earlier resolution of rectal bleeding, and higher odds of achieving overall remission. It is administered intravenously which allows immediate central distribution of the drug with maximum bioavailability in contrast to subcutaneous administration of golimumab that achieves 50% bioavailability. [Ref]
Conclusion:
Both Simponi and Remicade can be used in the above-mentioned disease conditions. Simponi is a better treatment option for rheumatoid arthritis. Both drugs have an equal risk-to-benefit ratio in ankylosing spondylitis. Remicade is better than Simponi in the treatment of psoriatic arthritis and ulcerative colitis.