Remicade alternatives: What can I take instead of Remicade?

Compare Remicade alternatives | Renflexis | Humira | Stelara | Xeljanz XR | Trexall | Natural alternatives | How to switch meds

Suppressing your own immune system by taking medication is naturally frightening but is absolutely necessary to control many autoimmune conditions. Crohn’s disease, ulcerative colitis, rheumatoid arthritis, psoriasis, psoriatic arthritis, and ankylosing spondylitis are all autoimmune diseases, and they stem from an immune system malfunction, which causes our immune cells to attack body parts such as bowel, joints, and skin. Remicade, a brand-name form of infliximab given intravenously, can be used to treat all of these medical conditions. Remicade is also FDA approved for use in pediatric patients ages six and older for the treatment of Crohn’s and ulcerative colitis. 

Due to the expense, its significant side effects (including the possibility of heart failure or nervous system problems), and the inconvenience of needing an intravenous infusion, you may be curious to know if an alternative to Remicade exists. The short answer is an emphatic ‘Yes,’ because there has been an impressive proliferation of these types of drugs. In fact, they pop up in commercials frequently. The long answer is more complex and worth delving into as we list the other options and hone in on the most common ones.

What can I take in place of Remicade?

Remicade belongs to the tumor necrosis factor (TNF) inhibitor subclass of immunosuppressants. By blocking TNF, the drug disrupts the chemical messaging between the body’s immune cells, which blunts the inflammation our immune system can produce. A number of other TNF inhibitors are available if Remicade is the wrong fit for you. 

In addition, Remicade falls under the larger category of biologics, a term under the umbrella of immunosuppressants. Alternative biologics block cytokines other than TNF. Interleukins (ILs) are a diverse group of cytokines, our body’s chemical signaling proteins and interleukin inhibitors may be another option for you. Biologic medications can also interrupt immune cell function in other ways.

Biologics may get a lot of attention, but they are far from the only choice. Janus kinase (JAK) inhibitors are medicines composed of small molecules that block immune cell internal processes. Like TNF and IL inhibitors, JAK blockers target the root cause of autoimmune disease. Biologics modify the disease itself rather than just covering up symptoms, and this feature earns them the distinction of disease-modifying antirheumatic drugs (DMARDs). More traditional DMARDs for you to consider might include methotrexate, hydroxychloroquine, sulfasalazine, and leflunomide. 

The classifications of immunosuppressants sound a bit like alphabet soup, with an abundance of acronyms like TNF, IL, JAK, and DMARDs. As we break the categories down to specific drugs, your options become more clear. The list is lengthy, so we will focus on a few common choices.

Other alternatives to Remicade

• Inflectra (infliximab)
• Avsola (infliximab)
• Actemra (tocilizumab)
• Kevzara (sarilumab)
• Siliq (brodalumab)
• Kineret (anakinra)
• Ilumya (tildrakizumab)
• Entyvio (vedolizumab)
• Tysabri (natalizumab)
• Olumiant (baricitinib)
• Xeljanz (tofacitinib)
• Rinvoq (upadacitinib)
• Imuran (azathioprine)
• Mercaptopurine
• Prednisone or other corticosteroids

Top 5 Remicade alternatives

The following are some of the most common alternatives to Remicade.

1. Renflexis

You would be hard-pressed to find a difference between Renflexis and Remicade. The reason is that Renflexis is one of the multiple biosimilars to Remicade, having only a minor, insignificant structural difference in the monoclonal antibody infliximab. Renflexis is biosimilar to Remicade, which accounts for their similarity in terms of effectiveness, dosage, and side effects. 

Biologics are very complex to manufacture, so when a product like Remicade is no longer under patent protection, competing companies can make an extremely similar drug, but not identical. The result is a biosimilar rather than an identical generic product. Cheaper development costs translate to a lower price for the consumer, meaning Renflexis might offer you savings compared to Remicade, without sacrificing safety or efficacy. Regardless of being biosimilar or not, biologics come at a hefty price. If cost is a major motivator for you to change drugs, try showing a SingleCare discount card at your local pharmacy to see if that helps you save money.

2. Humira

Convenience is always appreciated, and going to an infusion center to get intravenous Remicade every few weeks is not quick and easy. Humira presents as an alternative TNF inhibitor that can be injected at home every two weeks. The most common side effects of Humira include respiratory infections and abdominal pain. Since the list of diagnoses for which Humira is approved by the Food and Drug Administration (FDA) matches up nicely with Remicade, chances are that it is a viable option for you to consider. 

RELATED: Remicade vs. Humira: Differences, similarities, and which is better for you

3. Stelara

If you are looking for an alternative to Remicade because it has failed to control your autoimmune condition or has given you unacceptable side effects, Stelara could make your final list of possibilities. Instead of blocking TNF, Stelara is an antibody that binds to the interleukins IL-12 and IL-23. The inhibition of these cytokines reduces inflammation in many of the same diseases as Remicade. Generally, Stelara comes up for use when TNF agents have not worked out. Of the IL blockers, it has the advantage of only requiring an injection every 8 or 12 weeks.

4. Xeljanz XR

The bane of therapy with TNF or IL inhibitory agents is the large molecular size that requires them to be given intravenously or by injection. Janus kinase inhibitors are small molecules permitting them to be given as oral tablets. Remicade or another TNF inhibitor is often tried first, but a JAK inhibitor like Xeljanz XR can be an option thereafter if need be. Once daily dosing of a Xeljanz XR tablet probably sounds appealing compared to taking the time to go for a Remicade infusion. 

5. Trexall

Long before any form of biologic drug, there was a drug with utility for treating various arthritic and cancer conditions. Trexall is an oral form of methotrexate that can be taken once a week. The efficacy of methotrexate as a DMARD for rheumatoid arthritis is impressive enough that it is often used as a first-line treatment before biologic agents or other nonbiologic drugs, like Plaquenil, Arava, and Azulfidine. 

Natural alternatives to Remicade

The potency and potential of biologic and nonbiologic DMARDs are not in debate. These drugs can do wonders to reduce the damage done to joints in rheumatoid or psoriatic arthritis and the intestinal tract in inflammatory bowel diseases (IBD) like Crohn’s disease and ulcerative colitis. Unfortunately, their immunosuppressive mechanism is fraught with risk. The dangers include allergic reactions, serious infections, lymphoma, and other cancers, arising in the setting of less immune system surveillance. In fact, prior to treatment with Remicade, testing is typically done for latent tuberculosis and hepatitis B, because infections like this could reactivate if the immune system lets its guard down. This explains why many of the FDA-approved indications specify moderate to severe forms of the disease to warrant treatment with a biologic. Mild cases can be addressed with other anti-inflammatory prescription drugs.

Respect for the potential adverse effects is warranted, but the fear of them often pushes people to turn to unproven options. Natural alternatives are a popular pick. For example, interest exists in treating IBD with probiotics, prebiotics, antioxidants, and fish oil, and for each, the results of clinical trials have either been disappointing or insufficient to warrant their use at this time. The autoimmune conditions that DMARDs address are too damaging and disabling to make decisions without getting the medical advice of your healthcare provider.

How to switch to a Remicade alternative

At this point, you may have some valid points regarding wanting to switch away from Remicade, and you now know what alternative drugs sound best. Call up the prescribing healthcare professional and ask for an appointment to discuss your experiences with Remicade and your ideas about other options. Points about effectiveness, safety, risk factors, drug interactions, cost, and convenience can all be raised. At the conclusion of the discussion, a mutual decision can be made about your treatment.