| Rheumatoid Arthritis

Actemra vs Orencia

Side-by-side clinical, coverage, and cost comparison for rheumatoid arthritis.

Deep comparison between: Actemra vs Orencia with Prescriber.AI

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Safety signalsOrencia has a higher rate of injection site reactions vs Actemra based on FDA-approved prescribing information

Coverage gaps3 major payers require step therapy for Orencia but not Actemra, including UnitedHealthcare

Category

Actemra

Orencia

At A Glance

RouteIV infusion or SC injection

FrequencyEvery 4 weeks (IV) or Every week to Every other week (SC)

ClassIL-6 receptor antagonist

RouteSC injection, IV infusion

FrequencyWeekly (SC) or every 4 weeks (IV)

ClassSelective T-cell costimulation modulator

Indications

Rheumatoid Arthritis
Giant Cell Arteritis
Lung disease with systemic sclerosis
Juvenile polyarthritis
Systemic onset juvenile chronic arthritis
Cytokine Release Syndrome
COVID-19 Virus Disease

Rheumatoid Arthritis
Juvenile polyarthritis
Arthritis, Psoriatic
Acute GVH disease

Dosing

Rheumatoid Arthritis IV: 4 mg/kg every 4 weeks, increase to 8 mg/kg every 4 weeks based on response; SC: 162 mg every other week (for <100 kg) or every week (for >=100 kg), increase to every week based on response.

Giant Cell Arteritis IV: 6 mg/kg every 4 weeks with tapering glucocorticoids; SC: 162 mg every week with tapering glucocorticoids (may use every other week based on clinical considerations).

Systemic Sclerosis-Associated Interstitial Lung Disease SC: 162 mg every week.

Polyarticular Juvenile Idiopathic Arthritis IV: 10 mg/kg every 4 weeks (<30 kg) or 8 mg/kg every 4 weeks (>=30 kg); SC: 162 mg every 3 weeks (<30 kg) or every 2 weeks (>=30 kg).

Systemic Juvenile Idiopathic Arthritis IV: 12 mg/kg every 2 weeks (<30 kg) or 8 mg/kg every 2 weeks (>=30 kg); SC: 162 mg every 2 weeks (<30 kg) or every week (>=30 kg).

Cytokine Release Syndrome IV: 12 mg/kg (<30 kg) or 8 mg/kg (>=30 kg) as single dose, alone or with corticosteroids; up to 3 additional doses at least 8 hours apart if no improvement.

COVID-19 IV: 12 mg/kg (<30 kg) or 8 mg/kg (>=30 kg) as single 60-minute infusion; one additional dose at least 8 hours later if clinical signs worsen or do not improve.

Rheumatoid Arthritis IV: weight-based (500-1,000 mg) infused over 30 minutes at Weeks 0, 2, and 4, then every 4 weeks; SC: 125 mg once weekly, with optional IV loading dose on Day 1.

Juvenile polyarthritis IV (>=6 yrs): 10 mg/kg (body weight <75 kg) or adult weight-based dose (>=75 kg, max 1,000 mg) at Weeks 0, 2, and 4, then every 4 weeks; SC (>=2 yrs): 50 mg (10 to <25 kg), 87.5 mg (25 to <50 kg), or 125 mg (>=50 kg) once weekly without IV loading dose.

Arthritis, Psoriatic Adult IV: weight-based (500-1,000 mg) over 30 minutes at Weeks 0, 2, and 4, then every 4 weeks; Adult SC: 125 mg once weekly without IV loading dose; Pediatric SC (>=2 yrs): 50 mg (10 to <25 kg), 87.5 mg (25 to <50 kg), or 125 mg (>=50 kg) once weekly.

Acute GVH disease IV: patients >=6 yrs: 10 mg/kg (max 1,000 mg) over 60 minutes on Day -1, then Days 5, 14, and 28 post-transplant; patients 2 to <6 yrs: 15 mg/kg on Day -1, then 12 mg/kg on Days 5, 14, and 28.

Contraindications

Known hypersensitivity to tocilizumab

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Drug Interactions

856View drug interactions

1119View drug interactions

Adverse Reactions

Most common (>=5%) Upper respiratory tract infections, nasopharyngitis, headache, hypertension, increased ALT, injection site reactions (SC only).

Serious Serious infections (pneumonia, urinary tract infection, cellulitis, herpes zoster, gastroenteritis, diverticulitis, sepsis, bacterial arthritis), gastrointestinal perforations, hypersensitivity reactions including anaphylaxis.

Postmarketing Fatal anaphylaxis, Stevens-Johnson Syndrome, Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS), pancreatitis, drug-induced liver injury, hepatitis, hepatic failure, jaundice, hypofibrinogenemia.

Most common (>=10%) Headache, nasopharyngitis, upper respiratory tract infection, nausea (RA); in aGVHD: anemia, hypertension, CMV reactivation/infection, pyrexia, pneumonia, epistaxis, CD4 lymphocytes decreased, hypermagnesemia, acute kidney injury.

Serious Serious infections (pneumonia, cellulitis, urinary tract infection, bronchitis, diverticulitis), malignancies (lung cancer, lymphoma), hypersensitivity reactions, acute infusion-related reactions, COPD exacerbation.

Postmarketing Vasculitis (cutaneous and leukocytoclastic), new or worsening psoriasis, non-melanoma skin cancers (basal cell and squamous cell carcinoma), angioedema, fatal anaphylaxis (IV), systemic injection reactions (SC).

Pharmacology

Tocilizumab is a humanized IgG1 kappa monoclonal antibody that binds to soluble and membrane-bound IL-6 receptors, inhibiting IL-6-mediated signaling involved in inflammatory and immune processes.

Abatacept is a selective T-cell costimulation modulator that inhibits T-lymphocyte activation by binding to CD80 and CD86, thereby blocking the CD28 costimulatory interaction required for full T-cell activation; activated T lymphocytes are implicated in the pathogenesis of RA, pJIA, and PsA.

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Most Common Insurance

Anthem BCBS

Actemra