| Rheumatoid Arthritis
Acthar vs Orencia
Side-by-side clinical, coverage, and cost comparison for rheumatoid arthritis.Deep comparison between: Acthar vs Orencia with Prescriber.AI
AI compares prescribing info and payer-specific access barriers across 1,200+ formularies. Here's a preview of what prescribers are already asking.Safety signalsOrencia has a higher rate of injection site reactions vs Acthar based on FDA-approved prescribing information
Coverage gaps3 major payers require step therapy for Orencia but not Acthar, including UnitedHealthcare
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Category
Acthar
Orencia
At A Glance
IM or SC injection
Corticotropin analog
SC injection, IV infusion
Weekly (SC) or every 4 weeks (IV)
Selective T-cell costimulation modulator
Indications
- Infantile Spasm
- Multiple Sclerosis
- Arthritis, Psoriatic
- Rheumatoid Arthritis
- Ankylosing spondylitis
- Lupus Erythematosus, Systemic
- Dermatomyositis
- Polymyositis
- Erythema Multiforme
- Stevens-Johnson Syndrome
- Serum Sickness
- Keratitis
- Iritis
- Iridocyclitis
- Uveitis, Posterior
- Choroiditis
- Optic Neuritis
- Chorioretinitis
- Sarcoidosis
- Nephrotic Syndrome
- Rheumatoid Arthritis
- Juvenile polyarthritis
- Arthritis, Psoriatic
- Acute GVH disease
Dosing
Infantile Spasm 150 U/m2/day IM divided into 75 U/m2 twice daily for 2 weeks, then taper over 2 weeks; Acthar Gel vial only -- do not use the pre-filled SelfJect injector.
Multiple Sclerosis 80-120 units IM or SC daily for 2-3 weeks for acute exacerbations; taper as needed.
Arthritis, Psoriatic, Rheumatoid Arthritis, Ankylosing spondylitis, Lupus Erythematosus, Systemic, Dermatomyositis, Polymyositis, Erythema Multiforme, Stevens-Johnson Syndrome, Serum Sickness, Keratitis, Iritis, Iridocyclitis, Uveitis, Posterior, Choroiditis, Optic Neuritis, Chorioretinitis, Sarcoidosis, Nephrotic Syndrome 40-80 units IM or SC every 24-72 hours; individualize dosing based on disease severity and patient response; taper dose upon discontinuation.
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
- Intravenous administration
- Use in infants under 2 years of age with suspected congenital infections
- Concomitant live or live-attenuated vaccines during immunosuppressive doses of Acthar Gel
- Scleroderma
- Osteoporosis
- Systemic fungal infections
- Ocular herpes simplex
- Recent surgery
- History of or presence of peptic ulcer
- Congestive heart failure
- Uncontrolled hypertension
- Primary adrenocortical insufficiency
- Adrenocortical hyperfunction
- Sensitivity to proteins of porcine origin
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Adverse Reactions
Most common (>=5%) Infections, convulsions, hypertension, irritability, pyrexia (reported in infantile spasm trials at recommended dose)
Serious Cushing's syndrome, adrenal insufficiency upon withdrawal, elevated blood pressure, salt and water retention, hypokalemia, gastrointestinal perforation and bleeding, behavioral and mood disturbances, ophthalmic effects, decreased bone density, negative effects on growth and physical development
Postmarketing Anaphylaxis, necrotizing angitis, pancreatitis, intracranial hemorrhage, subdural hematoma, reversible brain shrinkage, vertebral compression fractures, insomnia, injection site reactions
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
Repository corticotropin (ACTH) analog that stimulates the adrenal cortex to secrete cortisol, corticosterone, aldosterone, and weak androgens; also reported to bind melanocortin receptors, with the trophic effects on the adrenal cortex appearing to be mediated by cyclic AMP.
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
Acthar
- Covered on 5 commercial plans
- PA (10/12) · Step Therapy (1/12) · Qty limit (0/12)
Orencia
- Covered on 5 commercial plans
- PA (10/12) · Step Therapy (10/12) · Qty limit (9/12)
UnitedHealthcare
Acthar
- Covered on 4 commercial plans
- PA (1/8) · Step Therapy (0/8) · Qty limit (0/8)
Orencia
- Covered on 4 commercial plans
- PA (5/8) · Step Therapy (5/8) · Qty limit (5/8)
Humana
Acthar
- Covered on 0 commercial plans
- PA (3/3) · Step Therapy (2/3) · Qty limit (2/3)
Orencia
- Covered on 0 commercial plans
- PA (3/3) · Step Therapy (3/3) · Qty limit (3/3)
Coverage data sourced from MMIT. Updated monthly.
Savings
No savings programs available for Acthar.
No savings programs available for Orencia.
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Clinical data sourced from FDA-approved labeling. Coverage data via MMIT. Updated monthly.