| Rheumatoid Arthritis

Acthar vs Ruxience

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

Deep comparison between: Acthar vs Ruxience with Prescriber.AI

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

Coverage gaps3 major payers require step therapy for Ruxience but not Acthar, including UnitedHealthcare

Category

Acthar

Ruxience

At A Glance

RouteIM or SC injection

ClassCorticotropin analog

RouteIV infusion

ClassCD20-directed cytolytic 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

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; once weekly for 4 or 8 doses (relapsed/refractory), on Day 1 of each chemotherapy cycle for up to 8 doses (previously untreated follicular or DLBCL), or every 8 weeks for 12 doses as single-agent maintenance.

Chronic Lymphocytic Leukemia 375 mg/m2 IV on Day 1 of Cycle 1, then 500 mg/m2 IV on Day 1 of Cycles 2-6 in combination with fludarabine and cyclophosphamide, every 28 days.

Rheumatoid Arthritis Two 1,000 mg IV infusions separated by 2 weeks (one course) every 24 weeks or based on clinical evaluation, but not sooner than every 16 weeks, in combination with methotrexate.

Granulomatosis with polyangiitis, Microscopic Polyarteritis Induction: 375 mg/m2 IV once weekly for 4 weeks; follow-up: two 500 mg IV infusions separated by 2 weeks, then 500 mg IV every 6 months based on clinical evaluation, in combination with glucocorticoids.

Pemphigus Vulgaris Two 1,000 mg IV infusions separated by 2 weeks plus tapering glucocorticoids; maintenance: 500 mg IV at Month 12 and every 6 months thereafter; relapse: 1,000 mg IV, no sooner than 16 weeks after the previous infusion.

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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Drug Interactions

648View drug interactions

537View drug interactions

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 (NHL); infusion-related reactions, neutropenia (CLL).

Serious Infusion-related reactions, severe mucocutaneous reactions, hepatitis B reactivation with fulminant hepatitis, progressive multifocal leukoencephalopathy, tumor lysis syndrome, infections, cardiovascular adverse reactions, renal toxicity, bowel obstruction and perforation.

Postmarketing Prolonged pancytopenia, marrow hypoplasia, late-onset neutropenia, fatal cardiac failure, uveitis, optic neuritis, systemic vasculitis, pleuritis, lupus-like syndrome, serum sickness, polyarticular arthritis, vasculitis with rash, viral infections including PML, Kaposi's sarcoma progression, severe mucocutaneous reactions, pyoderma gangrenosum, bowel obstruction and perforation, fatal bronchiolitis obliterans, fatal interstitial lung disease, PRES/RPLS.

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-pvvr is a chimeric monoclonal antibody that targets the CD20 antigen on pre-B and mature B-lymphocytes, mediating B-cell lysis through complement dependent cytotoxicity (CDC) and antibody dependent cell mediated cytotoxicity (ADCC).

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Most Common Insurance

Anthem BCBS

Acthar