Remicade vs. Humira

  • Medical Editor: John P. Cunha, DO, FACOEP
    John P. Cunha, DO, FACOEP

    John P. Cunha, DO, FACOEP

    John P. Cunha, DO, is a U.S. board-certified Emergency Medicine Physician. Dr. Cunha's educational background includes a BS in Biology from Rutgers, the State University of New Jersey, and a DO from the Kansas City University of Medicine and Biosciences in Kansas City, MO. He completed residency training in Emergency Medicine at Newark Beth Israel Medical Center in Newark, New Jersey.

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Remicade vs. Humira comparison

Remicade (infliximab) and Humira (adalimumab) are both laboratory-synthesized proteins. They are different chemicals on a molecular level, but they are designed to do the same thing: block a specific immune antibody that causes inflammation in a half-dozen different autoimmune disorders, including rheumatoid arthritis.

The side effects common to both Remicade and Humira include:

The chief worry for a patient taking these injections, however, is the risk of a bacterial or fungal infection. After all, the express goal of both Remicade and Humira is to suppress the immune system. This helps control the symptoms of autoimmune disorders, but also decreases your body's ability to fight infections.

Drug interactions are minimal, but doctors should never administer live vaccines to people taking infliximab and adalimumab because of the immune suppression effects mentioned above.

What are Remicade and Humira?

Remicade and Humira are injectable monoclonal antibodies (a type of synthesized protein made from cells in a lab) in the class of medications called TNF blockers or TNF inhibitors. This class also includes:

In autoimmune diseases like rheumatoid arthritis, psoriatic arthritis, Crohn's disease, psoriasis and the other conditions Remicade and Humira are approved to treat, the immune system mistakes the body's own cells for foreign ones and attacks them, causing inflammation, pain, tissue destruction and other associated symptoms.

TNF alpha (tumor necrosis factor alpha) is one of a number of different antibodies produced by white blood cells and other parts of the immune system. TNF alpha plays an important role in coordinating immune attacks on foreign invaders in the body, like viruses or bacteria. In the case of the disorders in question, the victims of the destruction initiated and controlled by TNF alpha are the body's own tissues.

Remicade, Humira and the other members of the TNF inhibitor class are different types of protein molecules all designed to achieve the same goal: binding to the TNF alpha molecules to render them harmless, thereby reducing inflammation, whether it's in the joints, skin, or bowels.

Neither Remicade nor Humira can cure any of the diseases for which they're approved as treatment, but each medication can dramatically reduce the symptoms, such as joint pain. Furthermore, in rheumatoid arthritis, infliximab and adalimumab can slow damage to the joint. Because both of these biologically derived medications (biologic drugs) modify the course of the disease in addition to alleviating symptoms, they are known as "disease-modifying anti-rheumatic drugs" or DMARDs.

Sometimes, infliximab or adalimumab are used in conjunction with other DMARDs that work by different mechanisms, such as Methotrexate (Rheumatrex). Methotrexate is an antimetabolite that interferes with cell function rather than blocking a specific antibody as infliximab and adalimumab do.

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What are the uses for Remicade and Humira?

Doctors prescribe infliximab and adalimumab for treatment of the following conditions:

What are the side effects of Remicade and Humira?

The side effects of Remicade and Humira are nearly the same, and they're similar to the other TNF inhibitors. Common side effects of both drugs include nausea, rash, stomach pain, and headache.

Infliximab can cause difficulty breathing, chest pain, problematic changes in blood pressure, fever, and chills.

Adalimumab can result in itching and rash around the injection site.

One of the biggest dangers of both these medications are opportunistic bacterial and fungal infections that take advantage of the immune weakness Remicade and Humira are designed to cause. Sepsis (bacterial blood infection) and tuberculosis are serious possibilities for those taking infliximab and adalimumab, as are minor problems like sinus infections and urinary tract infections.

Use of Remicade, Humira, and other TNF inhibitors has been linked to increased incidence of cancer in people taking them - notably, a correlation between infliximab use and malignant lymphoma. It's still not clear, however, whether the drugs themselves increase cancer risk, or whether people with the conditions that require TNF inhibitors for treatment are more at risk for cancer because of their autoimmune disorders.

Doctors who prescribe either Remicade or Humira must keep a close watch for allergic reactions - some of which can cause life-threatening anaphylaxis.

This is not a complete list of side effects. If your doctor decides to administer either Remicade or Humira, ask them for more information.

How should Remicade and Humira be taken (dosage)?

Remicade

  • Infliximab is administered intravenously as an injection.
  • The recommended dose is a 5 mg/kg infusion at 0, 2, and 6 weeks and then 5 mg/kg every 8 weeks for treatment of  moderate to severe active Crohn's disease or fistulizing Crohn's disease in adult or pediatric patients. Adults who initially responded then lost response may receive 10 mg/kg.
  • The recommended dose for the treatment of  rheumatoid arthritis is 3 mg/kg at 0, 2, and 6 weeks followed by 3 mg/kg every 8 weeks. Infliximab should be combined with methotrexate. If the person doesn't get better, their doctor may try up to 10 mg/kg or treating every 4 weeks.

Humira

  • Adalimumab is an injection under the skin.
  • The recommended dose for rheumatoid arthritis, ankylosing spondylitis, and psoriatic arthritis is 40 mg every other week, but some patients may need weekly administration.
  • Crohn's disease treatment starts with 160 mg initially, followed by 80 mg two weeks later, then 40 mg every 2 weeks.
  • Juvenile idiopathic arthritis is treated with 20 or 40 mg every other week and plaque psoriasis is treated with 80 mg followed by 40 mg every other week.

Which drugs interact with Remicade and Humira?

Some vaccines contain living bacteria and active viruses to condition the immune reaction. Doctors should never administer these vaccines to people taking either Remicade or Humira because of the infection risk.

Take neither infliximab nor adalimumab if you are taking other drugs, like anakinra (Kineret), which suppress the immune system as the effect will multiply.

Combination of Remicade and Humira with other, non biologic DMARDs like methotrexate can increase the symptom relief over prescribing either drug alone. Doctors, therefore, frequently prescribe TNF inhibitors and non biologic DMARDs in tandem.

Are Remicade and Humira safe to take during pregnancy or while breastfeeding?

Researchers haven't conducted studies of either of these drugs in pregnant or nursing mothers, though monkey studies of Humira showed no ill effects to the fetuses.

In the absence of research, doctors must weigh the risks and benefits before prescribing Remicade or Humira to pregnant or breastfeeding mothers.

Because of the potential immune suppression effects, however, the prescribing information recommends against administering live vaccines to a baby within six months of being exposed to a TNF inhibitor.

REFERENCE:

FDA Prescribing information

Summary for Gene 7124: TNF Tumor Necrosis Factor
HUGO Gene Nomenclature Committee
U.S. National Biotechnology Information Center

"The science behind the success of anti-TNF therapy"
Arthritis Today
Nov. 15, 2010
The Arthritis Foundation

"Disease-modifying anti-rheumatic drugs (DMARDs)"
UpToDate.com

Last Editorial Review: 2/27/2017

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Reviewed on 2/27/2017
References
REFERENCE:

FDA Prescribing information

Summary for Gene 7124: TNF Tumor Necrosis Factor
HUGO Gene Nomenclature Committee
U.S. National Biotechnology Information Center

"The science behind the success of anti-TNF therapy"
Arthritis Today
Nov. 15, 2010
The Arthritis Foundation

"Disease-modifying anti-rheumatic drugs (DMARDs)"
UpToDate.com

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