Is there an alternative to Rituxan? Understanding Your Options

October 7, 2025 •

3 min read

According to research published in 2023, several FDA-approved biosimilar versions of rituximab are considered highly similar to brand-name Rituxan and offer a safe and effective alternative for many patients. For those asking, "Is there an alternative to Rituxan?", options range from these cost-effective biosimilars to newer targeted therapies that work through entirely different mechanisms.

Quick Summary

Several alternatives exist for Rituxan, including biosimilar versions, next-generation anti-CD20 antibodies like obinutuzumab, and targeted therapies for specific conditions like CLL and rheumatoid arthritis.

Key Points

Biosimilars Offer Cost-Effective Options: Highly similar versions like Truxima, Ruxience, and Riabni provide effective treatment for many conditions at a potentially lower cost.
Next-Gen Anti-CD20s Expand Possibilities: Obinutuzumab and ofatumumab offer different properties and efficacy profiles compared to Rituxan for specific cancers and autoimmune conditions.
Newer Targeted Therapies Revolutionize Treatment: For CLL, Bruton's tyrosine kinase (BTK) inhibitors and BCL-2 inhibitors provide new, highly effective options, especially for high-risk patients.
Other Biologics Address Different Pathways: For rheumatoid arthritis, alternatives include TNF inhibitors and other biologics that target different parts of the immune system.
Individual Factors Dictate Choice: Patient-specific factors, such as diagnosis, disease subtype, treatment history, and cost, significantly influence the selection of the best therapeutic alternative.

Rituxan, the brand name for rituximab, is a powerful monoclonal antibody used to treat various conditions, including specific types of cancer and autoimmune diseases like rheumatoid arthritis. It works by targeting a protein called CD20 on the surface of B-cells, prompting the immune system to destroy them. However, factors such as cost, potential side effects, or lack of response may lead patients and healthcare providers to seek alternatives.

Understanding Rituxan's Mechanism of Action

Rituxan targets CD20-positive B-cells, triggering their destruction via Complement-Dependent Cytotoxicity (CDC), Antibody-Dependent Cellular Cytotoxicity (ADCC), and apoptosis. When an alternative is needed, it can be another anti-CD20 drug or a medication targeting different aspects of the disease.

Exploring Rituximab Biosimilars

Biosimilars are biologics deemed "highly similar" to Rituxan after rigorous testing, showing no clinically meaningful differences in safety, purity, or potency. They are often a lower-cost option.

FDA-approved biosimilars include Truxima (rituximab-abbs), Ruxience (rituximab-pvvr), and Riabni (rituximab-arrx). While similar in effectiveness, their approved uses may differ; some are not approved for pediatric use or pemphigus vulgaris.

Other Anti-CD20 Monoclonal Antibodies

Beyond biosimilars, newer anti-CD20 therapies with different properties exist.

Obinutuzumab (Gazyva): This glycoengineered antibody aims to enhance ADCC compared to rituximab. It has shown improved outcomes in some CLL trials and is used for specific NHL subtypes.
Ofatumumab (Arzerra, Kesimpta): A fully human anti-CD20 antibody with enhanced CDC. It is used for relapsing multiple sclerosis (Kesimpta) and previously for certain relapsed lymphomas.

Alternatives for Specific Conditions

Alternatives to Rituxan vary by condition.

For Non-Hodgkin's Lymphoma (NHL) and Chronic Lymphocytic Leukemia (CLL)

New targeted therapies have significantly changed the treatment of these blood cancers.

BTK Inhibitors: Oral drugs like ibrutinib, acalabrutinib, and zanubrutinib are effective, especially for patients with specific genetic mutations.
BCL-2 Inhibitors: Venetoclax targets the BCL-2 protein, often overexpressed in CLL. It's used alone or combined with other drugs.
PI3K Inhibitors: Idelalisib and duvelisib are options for relapsed CLL.
CAR T-Cell Therapy: An advanced immunotherapy for aggressive NHL.

For Rheumatoid Arthritis (RA)

Many biologic and synthetic options are available for RA.

TNF Inhibitors: Adalimumab, infliximab, and etanercept block TNF, reducing inflammation.
Other Biologics: Abatacept and tocilizumab target different immune components.
Targeted Synthetic DMARDs: Oral drugs like tofacitinib and upadacitinib are used when other treatments are insufficient.

Comparison of Anti-CD20 Therapies and Alternatives


Feature	Rituxan (rituximab)	Truxima (rituximab-abbs)	Obinutuzumab (Gazyva)	Acalabrutinib (Calquence)
Drug Class	Anti-CD20 Monoclonal Antibody	Anti-CD20 Monoclonal Antibody (Biosimilar)	Glycoengineered Anti-CD20 Antibody	Bruton's Tyrosine Kinase (BTK) Inhibitor
Mechanism	Targets and depletes B-cells	Targets and depletes B-cells	Enhances ADCC and direct cell death	Oral inhibitor of BTK, interfering with B-cell survival signals
Administration	Intravenous (IV) infusion	Intravenous (IV) infusion	Intravenous (IV) infusion	Oral capsule
Cost Potential	Higher (Brand Name)	Lower (Biosimilar)	Varies (Newer Biologic)	Varies (Targeted Therapy)
Main Indications	NHL, CLL, RA, Granulomatosis with Polyangiitis (GPA), Microscopic Polyangiitis (MPA), Pemphigus Vulgaris (PV)	Some NHL/CLL, RA, GPA, MPA (Not approved for pediatric or PV)	First-line CLL in combination therapy, certain NHL	CLL, Mantle Cell Lymphoma (MCL)

Conclusion

Numerous alternatives to Rituxan exist, with the optimal choice depending on the specific condition, patient history, and other factors. Biosimilars offer a similar and potentially more affordable option. Newer anti-CD20 agents or different targeted therapies may be more effective or better tolerated in some cases. Patients should discuss options with their healthcare provider to determine the most suitable treatment path.

For more information on drug options for lymphoma, visit the National Cancer Institute's website.

Frequently Asked Questions

Rituximab biosimilars are biologic drugs that are extensively studied and proven to be highly similar to the original brand-name Rituxan, with no clinically meaningful differences in safety or effectiveness for approved indications.

Yes, for the indications they are approved to treat, biosimilars have demonstrated equivalence in effectiveness and safety compared to Rituxan. The main exceptions are for pemphigus vulgaris and pediatric use, for which some biosimilars are not approved.

While both are anti-CD20 antibodies, obinutuzumab is a glycoengineered version designed to be more potent at depleting B-cells. Clinical trial results show obinutuzumab can offer superior progression-free survival for certain conditions like CLL compared to rituximab.

Alternatives for CLL include BTK inhibitors like ibrutinib (Imbruvica) and acalabrutinib (Calquence), BCL-2 inhibitors like venetoclax (Venclexta), and chemotherapy combinations.

Yes, many alternatives for RA target different immune pathways. These include TNF inhibitors (e.g., Humira, Remicade), other biologics (e.g., abatacept, tocilizumab), and targeted synthetic DMARDs (e.g., Xeljanz).

If a patient develops resistance, a healthcare provider may switch to a different anti-CD20 antibody like obinutuzumab or move to a different class of medication, such as a BTK inhibitor or BCL-2 inhibitor, depending on the disease.

Biosimilars are generally less expensive than brand-name Rituxan and can provide significant cost savings. Insurance coverage and patient assistance programs also play a large role in determining the most affordable option.