Rituxan vs. Actemra

Reviewed on 11/15/2021

Are Rituxan and Actemra the Same Thing?

Rituxan (rituximab) and Actemra (tocilizumab) are used to treat arthritis and many other conditions.

Rituxan is also used in combination with other cancer medicines to treat adults with Non-Hodgkin’s Lymphoma (NHL), Adults with Chronic Lymphocytic Leukemia (CLL), people with Granulomatosis with Polyangiitis (GPA) (Wegener’s Granulomatosis) and Microscopic Polyangiitis (MPA) ages 2 years and above, and adults with Pemphigus Vulgaris (PV).

Actemra is a prescription medicine called an Interleukin-6 (IL-6) receptor antagonist. Actemra is used:

  • To treat adults with moderately to severely active rheumatoid arthritis (RA), after at least one other medicine called a Disease-Modifying Anti-Rheumatic Drug (DMARD) has been used and did not work well.
  • To treat adults with giant cell arteritis (GCA).
  • For slowing the rate of decline in lung function in adults with systemic sclerosis-associated interstitial lung disease (SSc-ILD) (also known as scleroderma associated ILD).
  • To treat people with active PJIA ages 2 and above.
  • To treat people with active SJIA ages 2 and above.
  • To treat people age 2 years and above who experience severe or life-threatening Cytokine Release Syndrome (CRS) following chimeric antigen receptor (CAR) T cell treatment.
  • Actemra is not approved for subcutaneous use in people with CRS.

It is not known if Actemra is safe and effective in children with PJIA, SJIA, or CRS under 2 years of age or in children with conditions other than PJIA, SJIA or CRS.

Do not take ACTEMRA: if you are allergic to tocilizumab, or any of the ingredients in ACTEMRA.

Rituxan and Actemra belong to different drug classes. Actemra is an interleukin-6 (IL-6) receptor antagonist and Rituxan is a CD20-directed cytolytic antibody.

What Are Possible Side Effects of Rituxan?

Rituxan can cause serious side effects that can lead to death, including:
  • Infusion-related reactions. Infusion-related reactions are very common side effects of Rituxan treatment. Serious infusion-related reactions can happen during your infusion or within 24 hours after your infusion of Rituxan. Your healthcare provider should give you medicines before your infusion of Rituxan to decrease your chance of having a severe infusion-related reaction. Tell your healthcare provider or get medical help right away if you get any of these symptoms during or after an infusion of Rituxan:
  • Severe skin and mouth reactions. Tell your healthcare provider or get medical help right away if you get any of these symptoms at any time during your treatment with Rituxan:
    • painful sores or ulcers on your skin, lips or in your mouth
    • blisters
    • peeling skin
    • rash
    • pustules
  • Hepatitis B virus (HBV) reactivation. Before you receive your Rituxan treatment, your healthcare provider will do blood tests to check for HBV infection. If you have had hepatitis B or are a carrier of hepatitis B virus, receiving Rituxan could cause the virus to become an active infection again. Hepatitis B reactivation may cause serious liver problems including liver failure, and death. You should not receive Rituxan if you have active hepatitis B liver disease. Your healthcare provider will monitor you for hepatitis B infection during and for several months after you stop receiving Rituxan. Tell your healthcare provider right away if you get worsening tiredness, or yellowing of your skin or white part of your eyes, during treatment with Rituxan.
  • Progressive Multifocal Leukoencephalopathy (PML). PML is a rare, serious brain infection caused by a virus that can happen in people who receive Rituxan. People with weakened immune systems can get PML. PML can result in death or severe disability. There is no known treatment, prevention, or cure for PML.

  • Tell your healthcare provider right away if you have any new or worsening symptoms or if anyone close to you notices these symptoms:
    • confusion
    • dizziness or loss of balance
    • difficulty walking or talking
    • decreased strength or weakness on one side of your body
    • vision problems

Rituxan can cause serious side effects including:

  • Tumor Lysis Syndrome (TLS)
  • Serious infections
  • Heart problems
  • Kidney problems
  • Stomach and Serious bowel problems that can sometimes lead to death

The most common side effects of Rituxan include:

  • infusion-related reactions
  • infections (may include fever, chills)
  • body aches
  • tiredness
  • nausea

In adults with GPA or MPA the most common side effect of Rituxan also include:

  • low white and red blood cells
  • swelling
  • diarrhea
  • muscle spasms

Other side effects with Rituxan include:

  • aching joints during or within hours of receiving an infusion
  • more frequent upper respiratory tract infection

These are not all of the possible side effects with Rituxan.

QUESTION

The term arthritis refers to stiffness in the joints. See Answer

What Are Possible Side Effects of Actemra?

The most common side effects of ACTEMRA include:

Actemra can cause serious side effects including:

  1. Serious Infections. ACTEMRA is a medicine that affects your immune system. ACTEMRA can lower the ability of your immune system to fight infections. Some people have serious infections while taking ACTEMRA, including tuberculosis (TB), and infections caused by bacteria, fungi, or viruses that can spread throughout the body. Some people have died from these infections. Your healthcare provider should test you for TB before starting ACTEMRA.
    • You should not start taking ACTEMRA if you have any kind of infection unless your healthcare provider says it is okay.
    • think you have an infection or have symptoms of an infection, with or without a fever, such as:
    • are being treated for an infection.
    • get a lot of infections or have infections that keep coming back.
    • have diabetes, HIV, or a weak immune system. People with these conditions have a higher chance for infections.
    • have TB, or have been in close contact with someone with TB.
    • live or have lived, or have traveled to certain parts of the country (such as the Ohio and Mississippi River valleys and the Southwest) where there is an increased chance for getting certain kinds of fungal infections (histoplasmosis, coccidiomycosis, or blastomycosis). These infections may happen or become more severe if you use ACTEMRA. Ask your healthcare provider, if you do not know if you have lived in an area where these infections are common.
    • have or have had hepatitis B.
  2. Tears (perforation) of the stomach or intestines.
    • Tell your healthcare provider if you have had diverticulitis (inflammation in parts of the large intestine) or ulcers in your stomach or intestines. Some people taking ACTEMRA get tears in their stomach or intestine. This happens most often in people who also take nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids, or methotrexate.
    • Tell your healthcare provider right away if you have fever and stomach-area pain that does not go away, and a change in your bowel habits.
  3. Liver problems (Hepatotoxicity): Some people have experienced serious life-threatening liver problems, which required a liver transplant or led to death. Your healthcare provider may tell you to stop taking ACTEMRA if you develop new or worse liver problems during treatment with ACTEMRA. Tell your healthcare provider right away if you have any of the following symptoms:
    • feeling tired (fatigue)
    • lack of appetite for several days or longer (anorexia)
    • yellowing of your skin or the whites of your eyes (jaundice)
    • abdominal swelling and pain on the right side of your stomach-area
    • weakness
    • nausea and vomiting
    • confusion
    • dark “tea-colored” urine
    • light colored stools
  4. Changes in certain laboratory test results. Your healthcare provider should do blood tests before you start receiving ACTEMRA. If you have rheumatoid arthritis (RA) or giant cell arteritis (GCA) your healthcare provider should do blood tests every 4 to 8 weeks after you start receiving ACTEMRA for the first 6 months and then every 3 months after that. If you have polyarticular juvenile idiopathic arthritis (PJIA) you will have blood tests done every 4 to 8 weeks during treatment. If you have systemic juvenile idiopathic arthritis (SJIA) you will have blood tests done every 2 to 4 weeks during treatment. These blood tests are to check for the following side effects of ACTEMRA:
    • low neutrophil count. Neutrophils are white blood cells that help the body fight off bacterial infections.
    • low platelet count. Platelets are blood cells that help with blood clotting and stop bleeding.
    • increase in certain liver function tests.
    • increase in blood cholesterol levels. You may also have changes in other laboratory tests, such as your blood cholesterol levels. Your healthcare provider should do blood tests to check your cholesterol levels 4 to 8 weeks after you start receiving ACTEMRA.
  5. Cancer. ACTEMRA may increase your risk of certain cancers by changing the way your immune system works. Tell your healthcare provider if you have ever had any type of cancer.

What Is Rituxan?

Rituxan is a medication that is used to treat:

Non-Hodgkin's Lymphoma (NHL)

Rituxan (rituximab) is indicated for the treatment of adult patients with:

  • Relapsed or refractory, low-grade or follicular, CD20-positive, B-cell NHL as a single agent.
  • Previously untreated follicular, CD20-positive, B-cell NHL in combination with first line chemotherapy and, in patients achieving a complete or partial response to a rituximab product in combination with chemotherapy, as single-agent maintenance therapy.
  • Non-progressing (including stable disease), low-grade, CD20-positive, B-cell NHL as a single agent after first-line cyclophosphamide, vincristine, and prednisone (CVP) chemotherapy.
  • Previously untreated diffuse large B-cell, CD20-positive NHL in combination with cyclophosphamide, doxorubicin, vincristine, prednisone (CHOP) or other anthracycline-based chemotherapy regimens.

Chronic Lymphocytic Leukemia (CLL)

Rituxan, in combination with fludarabine and cyclophosphamide (FC), is indicated for the treatment of adult patients with previously untreated and previously treated CD20-positive CLL.

Rheumatoid Arthritis (RA)

Rituxan, in combination with methotrexate, is indicated for the treatment of adult patients with moderately-to severely-active rheumatoid arthritis who have had an inadequate response to one or more TNF antagonist therapies.

Granulomatosis With Polyangiitis (GPA) (Wegener's Granulomatosis) And Microscopic Polyangiitis (MPA)

Rituxan, in combination with glucocorticoids, is indicated for the treatment of adult and pediatric patients 2 years of age and older with Granulomatosis with Polyangiitis (GPA) (Wegener's Granulomatosis) and Microscopic Polyangiitis (MPA).

Pemphigus Vulgaris (PV)

Rituxan is indicated for the treatment of adult patients with moderate to severe pemphigus vulgaris.

What Is Actemra?

Actemra (tocilizumab) is an interleukin-6 (IL-6) receptor inhibitor used to treat moderate to severe rheumatoid arthritis in children and adults.

Additional uses of Actemra include polyarticular juvenile idiopathic arthritis (PJIA), systemic juvenile idiopathic arthritis (SJIA), giant cell arteritis (GCA), systemic sclerosis-associated interstitial lung disease (SSc-ILD), and cytokine release syndrome (CRS).

It is not known if Actemra is safe and effective in children with PJIA, SJIA, or CRS under 2 years of age or in children with conditions other than PJIA, SJIA or CRS.

Actemra for COVID-19
The FDA has issued an emergency use authorization (EUA) for Actemra for the treatment of coronavirus disease 2019 (COVID-19) in hospitalized adults and pediatric patients (2 years of age and older) who are receiving systemic corticosteroids and require supplemental oxygen, non-invasive or invasive mechanical ventilation, or extracorporeal membrane oxygenation (ECMO). Actemra is not FDA-approved for this use.  Actemra is authorized only for the duration of the declaration that circumstances exist justifying the authorization of the emergency use of Actemra.

What Drugs Interact With Rituxan?

Rituxan can cause renal toxicity when used in combination with cisplatin. Severe, including fatal, renal toxicity can occur after Rituxan administration in patients with NHL. Renal toxicity has occurred in patients who experience tumor lysis syndrome and in patients with NHL administered concomitant cisplatin therapy during clinical trials. The combination of cisplatin and Rituxan is not an approved treatment regimen. Monitor closely for signs of renal failure and discontinue Rituxan in patients with a rising serum creatinine or oliguria.

Formal drug interaction studies have not been performed with Rituxan. In patients with CLL, Rituxan did not alter systemic exposure to fludarabine or cyclophosphamide. In clinical trials of patients with RA, concomitant administration of methotrexate or cyclophosphamide did not alter the pharmacokinetics of rituximab.

Tell your healthcare provider about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements. Especially tell your doctor if you take or have taken:

  • a Tumor Necrosis Factor (TNF) inhibitor medicine
  • a Disease Modifying Anti-Rheumatic Drug (DMARD)

If you are not sure if your medicine is one listed above, ask your healthcare provider.

Additional information can be found in the US Prescribing Information, Section 7 DRUG INTERACTIONS.

What Drugs Interact With Actemra?

Actemra may interact with other drugs, including birth control pills, blood thinners, cyclosporine, digoxin, omeprozole, sirolimus, theophylline, abatacept, adalimumab, anakinra, certolizumab, etanercept, golimumab, infliximab, rituximab, cholesterol-lowering medications, seizure medications, heart rhythm medications, drugs that weaken your immune system, and pain or arthritis medications. Tell your doctor all medications and supplements you take. If you are pregnant, only take Actemra if the potential benefit outweighs the potential risk to the fetus. It is not known if Actemra passes into breast milk. Consult your doctor before breastfeeding.

Tell your healthcare provider about all of the medicines you take, including prescription, over-the-counter medicines, vitamins and herbal supplements. Actemra and other medicines may affect each other causing side effects. Especially tell your healthcare provider if you take: 

  • any other medicines to treat your RA. You should not take etanercept (Enbrel®), adalimumab (Humira®), infliximab (Remicade®), rituximab (Rituxan®), abatacept (Orencia®), anakinra (Kineret®), certolizumab (Cimzia®), or golimumab (Simponi®), while you are taking ACTEMRA. Taking ACTEMRA with these medicines may increase your risk of infection. 
  • medicines that affect the way certain liver enzymes work. Ask your healthcare provider if you are not sure if your medicine is one of these. 

Know the medicines you take. Keep a list of them to show to your healthcare provider and pharmacist when you get a new medicine.

Additional information can be found in the US Prescribing Information, Section 7 DRUG INTERACTIONS.

How Should Rituxan Be Taken?

Rituxan is administered under a physician's supervision. The dose of Rituxan varies depending on the disorder being treated and the number of infusions (doses) needed.

How Should Actemra Be Taken?

Actemra is available as an intravenous (IV) infusion or as a single-dose Prefilled Syringe or single-dose prefilled ACTPen® autoinjector for subcutaneous (SC) injection. The dose of Actemra varies depending on the condition being treated.  For rheumatoid arthritis, Actemra can be taken with or without methotrexate (or other disease-modifying anti-rheumatic drugs [DMARDS]).

SLIDESHOW

What Is Rheumatoid Arthritis (RA)? Symptoms, Treatment, Diagnosis See Slideshow
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References
SOURCE:

Genentech. Rituxan Product Information.

https://www.genentech-access.com/hcp/brands/rituxan/rituxan-ra.html


Genentech. Actemra Product Information.

https://www.actemra.com/

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