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Ninlaro vs Velcade, which is better?

Medically reviewed by Melisa Puckey, BPharm. Last updated on April 10, 2023.

Comparing Velcade to Ninlaro

Official answer


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.

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