Stelara vs Remicade For Crohn’s: What's The Difference?

Better understand the differences between Stelara and Remicade to make an informed decision about which treatment option is best for you.

Stelara and Remicade are two effective biological drugs for managing symptoms of severely active Crohn's disease and achieving clinical remission. 

It’s important to understand the differences between these two biological therapies to make an informed decision about which treatment option is best suited for your unique needs.

Stelara vs Remicade: top-line differences

Stelara (ustekinumab) is a prescription brand-name medication approved by the Food and Drug Administration (FDA). It's an immunosuppressant that belongs to the monoclonal antibody drug class. It works to treat moderate to severe Crohn’s disease in adults and, for both Crohn's disease and ulcerative colitis, it's administered via intravenous infusion followed by subcutaneous injections. 

Remicade  (infliximab) is an FDA-approved biologic used to treat psoriatic arthritis, inflammatory bowel disease (IBD) like Crohn's disease, ulcerative colitis, moderate to severe rheumatoid arthritis, ankylosing spondylitis, and certain severe skin disease (e.g., chronic plaque psoriasis). Janssen Biotech-manufactured Remicade is a TNF-blocker that works for medical conditions where the immune system attacks healthy tissues or organs.

The main difference between these medications is that Stelara requires one initial intravenous induction dose, followed by maintenance subcutaneous injections every 8 weeks. Remicade, on the other hand, requires intravenous doses at weeks 0, 2, and 6, followed by maintenance doses every 8 weeks.

Efficacy: Does Stelara work as well as Remicade?

According to clinical trials, by week 6 a number of patients have achieved clinical remission or clinical response with Remicade compared to patients receiving Stelara. But both of these biologic medications have similar efficacy and speed in patients with Crohn's disease who are “biologic-naïve” (i.e. those who have not received any form of biological medication).

Cost: What is the cost difference between Remicade and Stelara?

The cost of Remicade can range between $3k-$12k per treatment while the cost of Stelara is $25,497.12 every 8 weeks for the 90 mg dose.

READ MORE: How Much Does Remicade Infusion Cost?

How long it takes for Stelara and Remicade to work

The time it takes Remicade to take effect will vary by patient. Some patients may experience an improvement in symptoms after a few days while for others, it may take up to 6 weeks. Remicade is usually started at 5mg/kg, but if you are having an inadequate response, your healthcare professional may consider increasing your dosage to 10 mg/kg every 8 weeks. Typically, a patient receiving Remicade should experience benefits by week 14. If you don't respond by then, your healthcare professional may want to discuss other treatment options. 

In clinical studies of adults with Crohn’s disease who were being treated by Stelara, some recorded an improvement in symptoms (or remission) during their third week of treatment. However, it can take up to 8 weeks for Stelara to work.

READ MORE: How Long Does It Take For Remicade Infusions To Work?

Side effects of Stelara and Remicade

Side effects of Stelara

Mild side effects of Stelara include: 

• Urinary tract infection
• Itchy skin
• Upper respiratory infections like bronchitis, sinus infection or common cold
• Diarrhea
• Nausea and vomiting

Side effects typically resolve after a few days or weeks. It's crucial to consult your healthcare provider if they persist for longer or get severe.

Serious side effects

• Posterior Reversible Encephalopathy Syndrome (PRES)
• Lung inflammation
• Serious allergic reactions (feeling faint, skin rash, chest tightness)

Stelara may lower your ability to fight infections and increase your risk of serious infections like tuberculosis (TB) and other infections caused by fungi, viruses, or bacteria. Patients who have a genetic problem where the body does not make any of the proteins interleukin 12 (IL-12) and interleukin 23 (IL-23) are at a greater risk of experiencing serious infections.

Side effects of Remicade

Common side effects include: 

• Headache
• Abdominal pain
• Coughing
• Respiratory infection (sinus infection and sore throat)
• Redness at injection site

Other side effects include:

• Serious infections (like TB, blood infections, and pneumonia)
• Reactivation of HBV
• Lymphoma, or any other cancer in adults and children
• Skin cancer
• Cervical cancer
• Heart failure
• Shortness of breath
• Swelling of ankles or feet
• Sudden weight gain
• Liver injury—jaundice
• Lupus-like syndrome

Although rare, Remicade may cause allergic reactions during or after infusion, including hives, difficulty breathing, chest pain, high or low blood pressure, and fever or chills. Patients may also experience delayed allergic reactions, which may show up 3-12 days after infusion (fever, rash, headache, sore throat, muscle or joint pain, and swelling of the face and hands).

Patients using Remicade with methotrexate or corticosteroids are at a higher risk of serious infection from Remicade.  Refer to the prescribing information and medication guide for Remicade for more side effects.

READ MORE: Remicade Infusion: What To Expect & How To Prepare

Safety: Is Stelara a safe alternative to Remicade? 

Stelara is not associated with a higher risk of serious infections like other biologics. It also appears to be effective against paradoxical psoriasis caused by Remicade.

Additional treatment options for Crohn’s

Below are additional treatment options for Crohn’s that have been approved by the FDA.

Anti-tumor necrosis factor (anti-tnf) - Humira (adalimumab)

Humira (adalimumab) is an monoclonal antibody and TNF inhibitor used for patients with IBD. It is approved by the FDA to be used for adults and pediatric patients over the age of 6 who have ulcerative colitis or Crohn's disease. Common side effects include headaches, rashes, and nausea.

While using adalimumab, you should tell your healthcare professional about prescription and over-the-counter drugs, vitamins, herbal products, and nutritional supplements you are taking or intend to take. If you are pregnant or plan to become pregnant, it is best to inform your healthcare professional. Infants born to women receiving Humira should not receive live vaccines for 6 months. 

Interleukin-23 therapy - Skyrizi (risankizumab-rzaa)

Skyrizi is an intravenous biologic drug that targets interleukin-23, a type of protein that regulates immune responses. This medication works by reducing inflammation in patients who have Crohn’s disease. 

Anti-integrin therapy - Entyvio (vedolizumab)

Entyvio (vedolizumab), approved by the FDA in May 2014, belongs to a class of medications called monoclonal antibodies. It is an integrin receptor antagonist that works by binding to α4β7 integrin, thus preventing the integrin from causing inflammation associated with Crohn's disease.

Interested in learning more about Crohn’s treatment at Local Infusion?

Local Infusion offers modern, state-of-the-art centers with private suites, designed with your comfort in mind.

From questions on what to expect in your first treatment, to providing financial guidance and support, a dedicated Infusion Guide works with you and your physician to provide clear answers and assistance every step of the way. Plus, we take care of everything having to do with prior authorization. 

We’ll reach out within hours of a physician referral and get you digitally on board in less than two minutes, allowing our staff more time to focus on you.

Should you have questions regarding pricing and insurance, our team will work with you to provide financial assistance support and minimize costs, providing a simple and stress-free experience.