Ninlaro vs Velcade, which is better?
Comparing Velcade to Ninlaro
Ninlaro (ixazomib) and Velcade (bortezomib) are both targeted therapy anticancer drugs that belong to the same drug class of proteasome inhibitors, they both work inside cells to cause cancer cells to die. Velcade was the first one of these types of drugs developed and was approved in 2003, then after further research Ninlaro was developed and approved in 2015.
Ninlaro or Velcade, which one is better?
From the clinical trials of Ninlaro and Velcade the results show:
- Ninlaro in more convenient, as it is a weekly capsule
- Ninlaro is better tolerated as is has less severe side effects
- Overall response rate of both medicines was similar.
Ninlaro is used to treat multiple myeloma and Velcade can be used to treat multiple myeloma and mantle cell lymphoma.
Both Ninlaro and Velcade are used in combination with other medicines as part of their treatment plans.
Ninlaro has an advantage over Velcade, in that it is more convenient
- Ninlaro is an oral medicine so can be taken in capsule form compared to Velcade injection which needs to be given as intravenous injection (IV - into the vein) or subcutaneous (SC - under the skin), so Ninlaro is easier to take.
- Ninlaro's usual dose schedule is once a week, and Velcade is twice a week or weekly.
- Ninlaro is more convenient, as capsules are only taken weekly, and Velcade is an injection form given twice a week or weekly, which requires more clinic appointments and medical interventions.
| Ninlaro | Velcade | |
|---|---|---|
| What does it treat? | Multiple myeloma | Multiple myeloma and mantle cell lymphoma |
| Approval date | 2015 | 2003 |
| Drug Class | Proteasome inhibitor, blocks β5 of the 20S proteasome subunit (second generation) | Proteasome inhibitor, blocks β5 of the 20S proteasome subunit (first generation) |
| Form | Oral capsules | Injection: either intravenous (IV) or subcutaneous (SC) |
| Usual dose schedule | Once a week | Twice a week or weekly |
Ninlaro has an advantage over Velcade in that it has less side effects, so it is better tolerated.
- The Ninlaro trials show a smaller number of patients had the serious side effect of peripheral neuropathy (PN) and if they did have PN then it was less severe, compared to Velcade trials. In the Velade trials more patients experienced peripheral neuropathy and a larger percentage had a more severe grade of PN.
- The Ninlaro trials also show smaller numbers of patients with neutropenia (low level of neutrophils, a type of white blood cell), anemia (low levels of red blood cells) and shingles, when compared to the Velcade trial where these side effects affected a larger percentage of patients.
- As Ninlaro has less major side effects it is tolerated better, meaning the patient is more likely to be able to continue on treatment course with less interruptions and dose changes, while feeling better when compared to Velcade.
| Side effects | Ninlaro | Velcade |
|---|---|---|
| All peripheral sensory neuropathy | 27% | 44% |
| Grade 3 peripheral neuropathy | 2% | 13% |
| Neutropenia | 33% | 49% |
| Anemia | 29% | 43% |
| Shingles | 4% | 13% |
Response rate between the two drugs were similar but Velcade had a higher rate of complete responses compared to Ninlaro
- In the Velcade trial more patients had a complete response compared to the Nilaro trial.
- The Ninlaro trial showed a larger number of very good partial responses.
- Velcade had a larger number of patients having a better levels of response than Ninlaro, but Ninlaro’s overall response rate was slightly higher that Velcade
| Response rate | Ninlaro | Velcade |
|---|---|---|
| Overall response | 78% | 74% |
| Complete response | 12% | 33% |
| Very good partial response | 36% | 8% |
| Partial response | 30% | 33% |
| No response or relapse | 22% | 24 % |
| Duration of response, that was a partial response or higher (median) | 20.5 months | 19.9 months |
| Length of progression-free survival (median) | 21.4 months | 21.7 months |
Are Ninlaro and Velcade approved medicines by the FDA?
- Yes, Ninlaro is approved for multiple myeloma patients who have already tried one other therapy. It is used in combination with lenalidomide and dexamethasone.
- Yes, Velcade is approved for adult multiple myeloma patients and adult mantle cell lymphoma patients.
Bottom line:
- Ninlaro is used to treat multiple myeloma and Velcade can be used to treat multiple myeloma and mantle cell lymphoma.
- Ninlaro is a convenient capsule taken weekly, Velcade is an injection given twice weekly or weekly
- Ninlaro has less side effects, that are not as severe.
- Response rates overall for both Ninlaro and Velcade are similar, but Velcade has a higher percentage of patients in the complete response group.
References
- https://www.drugs.com/ninlaro.html
- https://www.drugs.com/pro/ninlaro.html
- https://www.nejm.org/doi/full/10.1056/NEJMoa1516282;
- https://www.nejm.org/doi/suppl/10.1056/NEJMoa1516282/suppl_file/nejmoa1516282_appendix.pdf;
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5495505/
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4508135/
- https://www.nejm.org/doi/full/10.1056/NEJMoa0801479;
- https://www.nejm.org/doi/suppl/10.1056/NEJMoa0801479/suppl_file/nejm_san_miguel_906sa1.pdf
Read next
How do you manage neuropathy from chemo?
Chemotherapy-induced peripheral neuropathy (CIPN) is a frequent and often distressing side effect of cancer treatment that affects the nerves. Common symptoms of CIPN are numbness, tingling, burning pain, and muscle weakness, which often occur in the hands and feet.
Continue reading
Is Velcade a type of chemotherapy?
Velcade is not a traditional form of chemotherapy (chemo). Velcade is a targeted drug therapy in the class of drugs known as proteasome inhibitors. Continue reading
How long does Velcade stay in your body?
You could expect Velcade to stay in your system ranging from 9 days (220 hours) to 44 days (1061 hours) depending on which dose you receive. Continue reading
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Related medical questions
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- What is Ninlaro used for?
- How much does Ninlaro cost compared to other chemo drugs?
- Is Ninlaro (ixazomib) a chemotherapy drug? How does it work?
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Drug information
Related support groups
- Velcade (5 questions, 14 members)
- Bortezomib (2 questions, 8 members)
- Ninlaro (6 questions, 5 members)
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