| Rheumatoid Arthritis
Acthar vs Rituxan
Side-by-side clinical, coverage, and cost comparison for rheumatoid arthritis.Deep comparison between: Acthar vs Rituxan 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 signalsRituxan has a higher rate of injection site reactions vs Acthar based on FDA-approved prescribing information
Coverage gaps3 major payers require step therapy for Rituxan but not Acthar, including UnitedHealthcare
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Category
Acthar
Rituxan
At A Glance
IM or SC injection
Corticotropin analog
IV infusion
Anti-CD20 monoclonal antibody
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
- Lymphoma, Non-Hodgkin
- Chronic Lymphocytic Leukemia
- Rheumatoid Arthritis
- Granulomatosis with polyangiitis
- Microscopic Polyarteritis
- Pemphigus Vulgaris
- Acute lymphocytic leukemia
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.
Lymphoma, Non-Hodgkin 375 mg/m2 IV; weekly for 4 or 8 doses for relapsed/refractory low-grade or follicular NHL; Day 1 of each chemotherapy cycle for up to 8 doses for previously untreated follicular or DLBCL; every 8 weeks for 12 doses as single-agent maintenance.
Acute lymphocytic leukemia 375 mg/m2 IV for 6 total infusions in combination with LMB chemotherapy (two doses during each of the two induction courses, one dose during each of the two consolidation courses) for pediatric patients aged 6 months and older.
Chronic Lymphocytic Leukemia 375 mg/m2 IV the day prior to initiation of cycle 1 FC chemotherapy, then 500 mg/m2 on Day 1 of cycles 2-6 every 28 days.
Rheumatoid Arthritis Two 1,000 mg IV infusions separated by 2 weeks per course in combination with methotrexate; subsequent courses every 24 weeks (no sooner than 16 weeks); premedicate with methylprednisolone 100 mg IV 30 minutes prior to each infusion.
Granulomatosis with polyangiitis, Microscopic Polyarteritis Induction: 375 mg/m2 IV once weekly for 4 weeks with glucocorticoids; follow-up: two 500 mg IV infusions separated by 2 weeks, then 500 mg IV every 6 months based on clinical evaluation.
Pemphigus Vulgaris Two 1,000 mg IV infusions separated by 2 weeks in combination with a tapering course of glucocorticoids; then 500 mg IV at Month 12 and every 6 months thereafter or based on clinical evaluation.
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 (>=25%) Infusion-related reactions, fever, lymphopenia, chills, infection, asthenia (in NHL); infusion-related reactions, neutropenia (in CLL)
Serious Fatal infusion-related reactions, severe mucocutaneous reactions, hepatitis B reactivation with fulminant hepatitis, progressive multifocal leukoencephalopathy, tumor lysis syndrome, sepsis, cardiovascular events, renal toxicity, bowel obstruction and perforation
Postmarketing Prolonged pancytopenia, fatal cardiac failure, progressive multifocal leukoencephalopathy, severe mucocutaneous reactions, pyoderma gangrenosum, bowel obstruction and perforation, fatal bronchiolitis obliterans, fatal interstitial lung disease, posterior reversible encephalopathy syndrome
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.
Rituximab is a chimeric murine/human IgG1 kappa monoclonal antibody that binds the CD20 antigen on pre-B and mature B-lymphocytes, mediating B-cell lysis via complement dependent cytotoxicity (CDC) and antibody dependent cell mediated cytotoxicity (ADCC).
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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)
Rituxan
- Covered on 5 commercial plans
- PA (10/12) · Step Therapy (10/12) · Qty limit (0/12)
UnitedHealthcare
Acthar
- Covered on 4 commercial plans
- PA (1/8) · Step Therapy (0/8) · Qty limit (0/8)
Rituxan
- Covered on 4 commercial plans
- PA (0/8) · Step Therapy (0/8) · Qty limit (0/8)
Humana
Acthar
- Covered on 0 commercial plans
- PA (3/3) · Step Therapy (2/3) · Qty limit (2/3)
Rituxan
- Covered on 0 commercial plans
- PA (3/3) · Step Therapy (3/3) · Qty limit (0/3)
Coverage data sourced from MMIT. Updated monthly.
Savings
No savings programs available for Acthar.
No savings programs available for Rituxan.
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Clinical data sourced from FDA-approved labeling. Coverage data via MMIT. Updated monthly.