Choosing the right treatment for chronic conditions like rheumatoid arthritis, Crohn’s disease, and psoriasis can be overwhelming. Remicade and Humira are two popular options, but each comes with its benefits, risks, and costs. In 2018, these medications made up nearly 50% of all biologic treatments for psoriasis in seven major developed countries, including the US.
This article aims to help by offering a clear comparison of Remicade vs Humira. Examining their benefits, risks, and costs provides patients and healthcare providers with the information needed to make an informed choice.
Remicade vs Humira Effectiveness
In examining the efficacy of Remicade (infliximab) and Humira (adalimumab), multiple clinical studies and reviews reveal insights into their performance in different conditions.
Humira vs Remicade for Crohn’s Disease
A large, real-life study in 2016 compared the efficacy and safety of adalimumab and infliximab for Crohn’s disease treatment. The findings showed that both medications exhibit similar response rates. However, for infliximab to attain optimal response maintenance, it necessitates using concomitant immunomodulators, unlike adalimumab, which is effective as a monotherapy.
Another study used propensity score matching to compare the effectiveness and safety of adalimumab and infliximab in children with Crohn’s disease over at least 24 months. The findings show that both treatments are similarly effective and safe for children who have not previously received biologic therapy.
Remicade vs Humira for Hidradenitis Suppurativa
Researchers looked at how well the two treatments work for hidradenitis suppurativa. In 2005, ten patients received infliximab infusions, and in 2009, another ten patients were given adalimumab injections. Both groups were monitored for a year using the same methods to measure disease severity, quality of life, inflammation levels, and overall treatment effectiveness.
The results showed that both treatments helped reduce the severity of hidradenitis suppurativa, but the infliximab group experienced a greater reduction in disease severity compared to the adalimumab group. Overall, infliximab proved to be more effective.
Humira vs Remicade for Ulcerative Colitis
An indirect treatment comparison meta-analysis of adalimumab vs infliximab was conducted in 2014 for the treatment of moderate to severe ulcerative colitis in adult patients naïve to anti-TNF therapy. Researchers analyzed data from five clinical trials and found that at 8 weeks, infliximab was significantly better than adalimumab in achieving clinical remission, clinical response, and mucosal healing.
However, after 52 weeks, there was no significant difference between the two drugs. Both treatments had similar rates of serious adverse events and discontinuations due to adverse events, showing no clear long-term advantage for either drug.
Remicade vs Humira for Plaque Psoriasis
Five systematic reviews (four of which included network meta-analyses and one that used traditional meta-analysis), along with a randomized controlled trial, indicated that adalimumab was less effective than infliximab and three other biologics in terms of achieving skin clearance and enhancing health-related quality of life for patients with moderate-to-severe plaque psoriasis.
Remicade vs Humira for Ankylosing Spondylitis
A study published in the Indian Journal of Pharmaceutical Sciences found that for patients with ankylosing spondylitis, adalimumab was more effective than infliximab in the following areas:
- Reducing the duration of morning stiffness.
- Lowering the visual analog scale (VAS) score, which is a measure of pain intensity.
- Reducing the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), which assesses disease activity.
However, adalimumab was less effective than infliximab in decreasing the levels of serum inflammatory cytokines, which are proteins involved in inflammation. The differences in effectiveness between the two drugs may be due to their distinct biological structures. However, further research is needed to fully understand the specific reasons behind these differences.
Remicade vs Humira for Psoriatic Arthritis
An old study conducted a matching-adjusted indirect comparison of adalimumab vs etanercept and infliximab for the treatment of psoriatic arthritis. Results showed that adalimumab was more effective than infliximab in achieving a significant clinical improvement (ACR70) at 14 weeks. ACR70 refers to a 70% improvement in the number of tender and swollen joints, as well as other criteria such as pain and disability.
Remicade vs Humira for Rheumatoid Arthritis
Experts evaluated the clinical effectiveness of adalimumab, etanercept, and infliximab for treating rheumatoid arthritis in adults. Their findings revealed that adalimumab and infliximab are both effective in reducing the symptoms and signs of rheumatoid arthritis. However, adalimumab demonstrated higher response rates across ACR20, ACR50, and ACR70 compared to infliximab. These criteria are used to measure the level of improvement in patients with rheumatoid arthritis.
Remicade vs Humira for Juvenile Idiopathic Arthritis (JIA)
A systematic literature review evaluated the efficacy and safety of tumor necrosis factor inhibitors in treating JIA. For adalimumab and infliximab, the results are:
| Parameters | Adalimumab Response Rate at Week 12 | Infliximab Response Rate at Week 14 |
| JIA-ACR30 (30% improvement) | 71-94% | 64% |
| JIA-ACR50 (50% improvement) | 68-90% | 50% |
| JIA-ACR70 (70% improvement) | 55-61% | 22% |
| JIA-ACR90 (90% improvement) | 39-42% | Not reported |
Remicade vs Humira for Non-Infectious Uveitis
A recent study compared the efficacy and safety of adalimumab and infliximab for treating non-infectious uveitis. Data from 11 clinical trials with 1,459 patients showed no significant difference between the two drugs in achieving complete remission of inflammation, response to therapy, or corticosteroid-sparing effects. The study concludes that both drugs are similarly effective.
Summary of Adalimumab vs Infliximab in Terms of Efficacy
The following table summarizes the comparative efficacy of Remicade and Humira across various conditions based on clinical studies and reviews:
| Condition | Remicade (Infliximab) | Humira (Adalimumab) |
| Crohn’s Disease | Comparable when used with concomitant immunomodulators | Comparable and effective as monotherapy |
| Hidradenitis Suppurativa | More effective | Less effective |
| Ulcerative Colitis | More effective at 8 weeks | Less effective at 8 weeks, but comparable to infliximab at 52 weeks |
| Plaque Psoriasis | More effective | Less effective |
| Ankylosing Spondylitis | Less effective in reducing morning stiffness, pain, and disease activity but more effective in reducing inflammatory cytokines | More effective in reducing morning stiffness, pain, and disease activity but less effective in reducing inflammatory cytokines |
| Psoriatic Arthritis | Less effective | More effective |
| Rheumatoid Arthritis | Less effective | More effective |
| Juvenile Idiopathic Arthritis | Less effective | More effective |
| Non-Infectious Uveitis | Comparable | Comparable |
Humira vs Remicade Side Effects
Being aware of each medication’s side effects and potential hazards allows individuals to evaluate the benefits and risks, helping them make informed choices about their treatment options.
Humira Side Effects
Humira comes with a range of potential side effects and risks that users should be aware of.
Common Side Effects
Patients using Humira may experience various common side effects, particularly at the injection site. These include pain, redness, rash, swelling, itching, or bruising. Additionally, some users report upper respiratory infections such as sinus infections, headaches, general rash, and nausea.
Serious Adverse Events
Humira can cause several serious side effects that require immediate medical attention. These include:
- Serious Infections
- Hepatitis B Reactivation
- Allergic Reactions
- Nervous System Issues
- Blood Disorders
- Heart Failure
- Immune Reactions
- Liver Problems
- Psoriasis
Risk of Malignancies
Humira increases the risk of serious infections and certain cancers. Users, including children and adults, have a higher likelihood of developing lymphoma and other cancers. Reports indicate that some young individuals have developed hepatosplenic T-cell lymphoma, a rare and often fatal cancer.
Additionally, there is an increased risk of skin cancers, such as basal cell carcinoma and squamous cell carcinoma, which are generally not life-threatening if treated promptly. Patients should notify their doctor if they notice any unusual bumps or open sores that do not heal.
Remicade Side Effects
Similarly, Remicade is also associated with potential side effects and risks that patients need to be aware of.
Common Side Effects
In clinical trials, the most frequent side effects experienced by more than 10% of Remicade-treated patients include infections such as upper respiratory infections, sinusitis, and pharyngitis. Other common adverse reactions are infusion-related reactions, headaches, and abdominal pain.
Serious Adverse Events
Remicade has been associated with several serious side effects, which necessitate careful monitoring and, in some cases, discontinuation of the medication:
- Serious Infections
- Hepatitis B Reactivation
- Hepatotoxicity
- Heart Failure
- Cytopenias (may include anemia, leukopenia, neutropenia, thrombocytopenia)
- Hypersensitivity Reactions
- Demyelinating Disease
- Lupus-like Syndrome
Risk of Malignancies
The use of Remicade has been linked to an increased risk of malignancies. Lymphoma and other cancers, some fatal, have been reported in children and adolescents treated with TNF blockers, including Remicade. These malignancies often appear after about 30 months of therapy, and many patients were also on immunosuppressants.
Postmarketing cases of hepatosplenic T-cell lymphoma, a rare and aggressive cancer, have been observed in patients treated with TNF blockers like Remicade, particularly in adolescent and young adult males with Crohn’s disease or ulcerative colitis who were also treated with azathioprine or 6-mercaptopurine. Reports have also indicated instances of melanoma and Merkel cell carcinoma. Regular skin examinations are recommended, especially for those at risk for skin cancer.
A retrospective cohort study indicated a 2- to 3-fold increase in invasive cervical cancer in women with rheumatoid arthritis treated with Remicade compared to biologic-naïve patients or the general population, particularly those over 60 years of age. Periodic cervical cancer screening should continue for women undergoing Remicade treatment.
Humira vs Remicade Mechanism of Action
Humira, which contains adalimumab, is a fully human monoclonal antibody that binds directly to tumor necrosis factor-alpha (TNF-alpha), a cytokine involved in systemic inflammation. By attaching itself to TNF-alpha, Humira prevents this cytokine from interacting with TNF receptors on the surface of cells. This blockade inhibits the inflammatory cascade that TNF-alpha typically initiates, reducing inflammation and the associated symptoms of autoimmune diseases.
On the other hand, Remicade, containing the active ingredient infliximab, is a chimeric monoclonal antibody composed of both human and mouse protein sequences. Similar to Humira, Remicade targets TNF-alpha. However, it works by binding to both soluble and transmembrane forms of TNF-alpha, thereby neutralizing its activity.
Remicade’s dual binding capability can effectively modulate the immune response, providing relief from the symptoms of autoimmune disorders. Although both Humira and Remicade aim to neutralize TNF-alpha their structural differences lead to distinct therapeutic effects and potential side effects.
Humira’s fully human composition means it’s less likely to provoke an immune response. Meanwhile, Remicade’s chimeric nature (part human, part mouse) can increase the risk of immunogenic reactions, potentially leading to reduced efficacy over time as the body might develop antibodies against it.
Indications and Approvals of Humira vs Remicade
Humira and Remicade are two well-known biologic therapies used to treat a range of autoimmune and inflammatory disorders.
FDA-Approved Indications
In August 1998, Remicade received accelerated approval for the acute treatment of moderate-to-severe Crohn’s disease in patients who had not responded adequately to conventional therapy and those with fistulizing disease.
This approval marked Remicade as the first TNF-alpha inhibitor available in the US. Subsequently, on December 31, 2002, the FDA approved Humira for the treatment of rheumatoid arthritis, becoming the third TNF-alpha inhibitor.
| Conditions | Humira | Remicade |
| Rheumatoid Arthritis | Approved | Approved |
| Psoriatic Arthritis | Approved | Approved |
| Ankylosing Spondylitis | Approved | Approved |
| Crohn’s Disease | Approved | Approved |
| Ulcerative Colitis | Approved | Approved |
| Plaque Psoriasis | Approved | Approved |
| Juvenile Idiopathic Arthritis | Approved | Not Approved |
| Hidradenitis Suppurativa | Approved | Not Approved |
| Uveitis | Approved | Not Approved |
| Pediatric Crohn’s Disease | Approved (6 years of age and older) | Approved (6 years of age and older) |
| Pediatric Ulcerative Colitis | Approved (5 years of age and older) | Approved (6 years of age and older) |
Off-Label Uses
Remicade and Humira are also occasionally prescribed off-label for a range of conditions. These include:
| Conditions | Humira | Remicade |
| Sarcoidosis | ||
| Pyoderma Gangrenosum | ||
| Relapsing Polychondritis | ||
| Behcet Disease | ||
| Pityriasis Rubra Pilaris | ||
| Juvenile Idiopathic Arthritis | ||
| Lichen Panus | ||
| Alopecia Areata | ||
| Pustular Psoriasis | ||
| Synovitis, Acne, Pustulosis, Hyperostosis, and Osteitis Syndrome (SAPHO Syndrome) | ||
| Granulomatosis with Polyangiitis (Wegener Granulomatosis) | ||
| Uveitis | FDA-approved | |
| Pemphigus | ||
| Multicentric Reticulohistiocytosis | ||
| Hidradenitis Suppurativa | FDA-approved | |
| Sjögren’s Syndrome | ||
| Vasculitis | ||
| Graft-versus-host Disease (GVHD) |
Dosing and Administration
When selecting a treatment, the available dosage strengths and forms are essential considerations for ensuring proper administration and patient convenience. Below is a comparison of the dosage strengths and forms for Remicade vs. Humira.
Humira Doses
- Single-dose prefilled pen (HUMIRA Pen):
-
- 80 mg/0.8 mL
- 40 mg/0.8 mL
- 40 mg/0.4 mL
- Single-dose prefilled syringe:
-
- 80 mg/0.8 mL
- 40 mg/0.8 mL
- 40 mg/0.4 mL
- 20 mg/0.4 mL
- 20 mg/0.2 mL
- 10 mg/0.2 mL
- 10 mg/0.1 mL
- Single-dose vial (for institutional use only):
-
- 40 mg/0.8 mL
Remicade Doses
- Single-dose vial:
-
- Each vial contains 100 mg of infliximab as a lyophilized powder
Here’s a detailed comparison of their respective dosages and administration guidelines:
| Aspect | Humira (for subcutaneous use) | Remicade (for intravenous use) |
| Rheumatoid Arthritis | 40 mg every other week | 3 mg/kg at 0, 2, and 6 weeks, then 3 mg/kg every 8 weeks. For incomplete response, consider up to 10 mg/kg every 8 weeks or every 4 weeks. |
| Psoriatic Arthritis | 40 mg every other week | 5 mg/kg at 0, 2, and 6 weeks, then 5 mg/kg every 8 weeks |
| Ankylosing Spondylitis | 40 mg every other week | 5 mg/kg at 0, 2, and 6 weeks, then 5 mg/kg every 6 weeks. |
| Juvenile Idiopathic Arthritis | 10 mg every other week (10 to <15 kg)
20 mg every other week (15 to <30 kg) 40 mg every other week (?30 kg) |
Not indicated for JIA |
| Hidradenitis Suppurativa | For adults: 160 mg on Day 1, 80 mg on Day 15, and 80 mg every other week or 40 mg every week starting on Day 29
For adolescents (30 to <60 kg): 80 mg on Day 1, 40 mg every other week starting on Day 8 For adolescents (?60 kg): 160 mg on Day 1, 80 mg on Day 15, and 80 mg every other week or 40 mg every week starting on Day 29 |
Not indicated for HS |
| Crohn’s Disease | 160 mg on Day 1, 80 mg on Day 15, and 40 mg every other week starting on Day 29 | 5 mg/kg at 0, 2, and 6 weeks, then 5 mg/kg every 8 weeks. For patients who lose response, consider increasing to 10 mg/kg every 8 weeks. |
| Pediatric Crohn’s Disease | For children (17 to <40 kg): 80 mg on Day 1, 40 mg on Day 15, and 20 mg every other week starting on Day 29
For children (?40 kg): 160 mg on Day 1, 80 mg on Day 15, and 40 mg every other week starting on Day 29 |
5 mg/kg at 0, 2, and 6 weeks, then 5 mg/kg every 8 weeks |
| Ulcerative Colitis | 160 mg on Day 1, 80 mg on Day 15, and 40 mg every other week starting on Day 29 | 5 mg/kg at 0, 2, and 6 weeks, then 5 mg/kg every 8 weeks |
| Pediatric Ulcerative Colitis | For children (20 to <40 kg): 80 mg on Day 1, 40 mg on Day 8 and Day 15, and 40 mg every other week or 20 mg every week starting on Day 29
For children (?40 kg): 160 mg on Day 1, 80 mg on Day 8 and Day 15, and 80 mg every other week or 40 mg every week starting on Day 29 |
5 mg/kg at 0, 2, and 6 weeks, then 5 mg/kg every 8 weeks |
| Plaque Psoriasis | 80 mg starting dose, then 40 mg every other week starting one week after the initial dose | 5 mg/kg at 0, 2, and 6 weeks, then 5 mg/kg every 8 weeks |
| Adult Uveitis | 80 mg starting dose, then 40 mg every other week starting one week after the initial dose | Not indicated for Uveitis |
Dosing and Administration
When selecting a treatment, the available dosage strengths and forms are essential considerations for ensuring proper administration and patient convenience. Below is a comparison of the dosage strengths and forms for Remicade vs. Humira.
Humira Doses
- Single-dose prefilled pen (HUMIRA Pen):
-
- 80 mg/0.8 mL
- 40 mg/0.8 mL
- 40 mg/0.4 mL
- Single-dose prefilled syringe:
-
- 80 mg/0.8 mL
- 40 mg/0.8 mL
- 40 mg/0.4 mL
- 20 mg/0.4 mL
- 20 mg/0.2 mL
- 10 mg/0.2 mL
- 10 mg/0.1 mL
- Single-dose vial (for institutional use only):
-
- 40 mg/0.8 mL
Remicade Doses
- Single-dose vial:
-
- Each vial contains 100 mg of infliximab as a lyophilized powder
Here’s a detailed comparison of their respective dosages and administration guidelines:
| Aspect | Humira (for subcutaneous use) | Remicade (for intravenous use) |
| Rheumatoid Arthritis | 40 mg every other week | 3 mg/kg at 0, 2, and 6 weeks, then 3 mg/kg every 8 weeks. For incomplete response, consider up to 10 mg/kg every 8 weeks or every 4 weeks. |
| Psoriatic Arthritis | 40 mg every other week | 5 mg/kg at 0, 2, and 6 weeks, then 5 mg/kg every 8 weeks |
| Ankylosing Spondylitis | 40 mg every other week | 5 mg/kg at 0, 2, and 6 weeks, then 5 mg/kg every 6 weeks. |
| Juvenile Idiopathic Arthritis | 10 mg every other week (10 to <15 kg)
20 mg every other week (15 to <30 kg) 40 mg every other week (?30 kg) |
Not indicated for JIA |
| Hidradenitis Suppurativa | For adults: 160 mg on Day 1, 80 mg on Day 15, and 80 mg every other week or 40 mg every week starting on Day 29
For adolescents (30 to <60 kg): 80 mg on Day 1, 40 mg every other week starting on Day 8 For adolescents (?60 kg): 160 mg on Day 1, 80 mg on Day 15, and 80 mg every other week or 40 mg every week starting on Day 29 |
Not indicated for HS |
| Crohn’s Disease | 160 mg on Day 1, 80 mg on Day 15, and 40 mg every other week starting on Day 29 | 5 mg/kg at 0, 2, and 6 weeks, then 5 mg/kg every 8 weeks. For patients who lose response, consider increasing to 10 mg/kg every 8 weeks. |
| Pediatric Crohn’s Disease | For children (17 to <40 kg): 80 mg on Day 1, 40 mg on Day 15, and 20 mg every other week starting on Day 29
For children (?40 kg): 160 mg on Day 1, 80 mg on Day 15, and 40 mg every other week starting on Day 29 |
5 mg/kg at 0, 2, and 6 weeks, then 5 mg/kg every 8 weeks |
| Ulcerative Colitis | 160 mg on Day 1, 80 mg on Day 15, and 40 mg every other week starting on Day 29 | 5 mg/kg at 0, 2, and 6 weeks, then 5 mg/kg every 8 weeks |
| Pediatric Ulcerative Colitis | For children (20 to <40 kg): 80 mg on Day 1, 40 mg on Day 8 and Day 15, and 40 mg every other week or 20 mg every week starting on Day 29
For children (?40 kg): 160 mg on Day 1, 80 mg on Day 8 and Day 15, and 80 mg every other week or 40 mg every week starting on Day 29 |
5 mg/kg at 0, 2, and 6 weeks, then 5 mg/kg every 8 weeks |
| Plaque Psoriasis | 80 mg starting dose, then 40 mg every other week starting one week after the initial dose | 5 mg/kg at 0, 2, and 6 weeks, then 5 mg/kg every 8 weeks |
| Adult Uveitis | 80 mg starting dose, then 40 mg every other week starting one week after the initial dose | Not indicated for Uveitis |
Biosimilars for Humira and Remicade
A biosimilar is a type of biological product that is highly similar to an already FDA-approved biological product, known as the reference product. Biosimilars have no clinically meaningful differences in terms of safety, purity, and potency compared to the reference product. They are designed to have the same mechanism of action, route of administration, dosage form, and strength as the original biological product.
Biosimilars for Humira
| Biosimilar | Active Ingredient | Approval Date | Interchangeability with Humira | Citrate-Free | Latex-Free |
| Amgevita | adalimumab-atto | September 2016 | No | Yes | Yes |
| Cyltezo | adalimumab-adbm | August 2017 | Yes | Yes | No |
| Hadlima | adalimumab-bwwd | July 2019 | No | High-concentration doses are citrate-free | Yes |
| Hulio | adalimumab-fkjp | July 2020 | No | Yes | Yes |
| Hyrimoz | adalimumab-adaz | October 2018 | No | High-concentration doses are citrate-free | Yes |
| Idacio | adalimumab-aacf | December 2022 | No | Yes | Yes |
| Yuflyma | adalimumab-aaty | May 2023 | No | Yes | Yes |
| Yusimry | adalimumab-aqvh | December 2021 | No | Yes | Yes |
| Abrilada | adalimumab-afzb | November 2019 | Yes | Yes | Yes |
| Simlandi | adalimumab-ryvk | February 2024 | Yes | Yes | Yes |
Source: CardinalHealth and GoodRx Health
Biosimilars for Remicade
| Biosimilar | Active Ingredient | Approval Date | Interchangeability with Remicade | Latex-Free |
| Inflectra | infliximab-dyyb | April 2016 | No | Yes |
| Renflexis | infliximab-abda | May 2017 | No | Yes |
| Avsola | infliximab-axxq | December 2019 | No | Yes |
Cost of Humira vs Remicade
Humira and Remicade are known for their high cost, often reaching up to $7,000 per month. While biosimilars present a more affordable option, they remain expensive, with prices up to $1,000.
For individuals with a prescription, Canadian mail-order pharmacies like Pharma Giant offer a more cost-effective solution. At Pharma Giant, Humira Pens are available starting at $1,249, and Remicade vials begin at $1,499. The pharmacy also provides additional discounts for larger quantity orders. Furthermore, Pharma Giant ensures expedited delivery, typically within 3-5 business days, making it a convenient option for those in need of these medications.
Wrap Up
Humira and Remicade are potent medications used to manage autoimmune conditions like rheumatoid arthritis, Crohn’s disease, and ulcerative colitis. While both drugs target the same inflammatory pathways, their administration methods and dosing schedules offer different conveniences to patients.
Humira’s self-injectable form provides the flexibility of home administration, appealing to those seeking independence and ease of use. On the other hand, Remicade’s requirement for regular infusions at a medical facility can be seen as a disadvantage, as it necessitates frequent visits for administration.
The choice between Humira and Remicade should be made based on individual patient needs, lifestyle preferences, and specific medical considerations. Consulting with a healthcare provider is essential to determine the most appropriate treatment plan.
Frequently Asked Questions
Related Articles
Sources
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