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Tocilizumab (Actemra) is a biologic drug approved to treat rheumatoid arthritis (RA) in adults and polyarticular juvenile rheumatoid arthritis (PJIA) and the systemic form of juvenile idiopathic arthritis (SJIA) in children. Biologic drugs are man-made through genetic engineering techniques and closely related to a protein that occurs naturally in the body. They are used to suppress the immune system in autoimmune disease.
Tocilizumab is used to treat inflammation. There are many pathways that can be blocked to stop the inflammation from harming the joints. Tocilizumab blocks the interleukin (IL)-6 receptor to stop the production of inflammation in the body. The medicine is injected once every 1-2 weeks or infused into your body through and IV each month.
Tocilizumab has been approved by the Food and Drug Administration for use in patients with moderate to severe rheumatoid arthritis who have failed to respond to disease modifying antirheumatic drugs ⎼ also called DMARDs. These include other biologic response modifiers such as TNF inhibitors or methotrexate.
Tocilizumab may be given alone or in combination with a DMARD, such as methotrexate and/or other non-biologic drugs. It is also approved for use in children over 2 years of age with the systemic form of JIA and/or polyarticular Juvenile Idiopathic Arthritis (PJIA). Studies of the use of tocilizumab in children with systemic JIA showed improvement in fevers, a feeling of well-being, and in blood tests that measure inflammation.
Tocilizumab is given as an infusion into a vein, either in the hospital or in a doctor's office. The infusions, which take about an hour, are repeated every 4 weeks. Although some patients may improve during the weeks after the first infusion, it may take as long as 6 -12 weeks to see results. For children with systemic JIA, dosing can be as frequent as every two weeks. The tocilizumab dose is adjusted according to the patient's weight. The starting dose in adults is 4 milligrams of tocilizumab per kilogram of body weight, but the dose can be increased to 8 milligrams per kilogram if needed to control arthritis. In children, the dose is 8 milligrams per kilogram in those weighing over 30 kilograms (66 pounds) and 12 milligrams per kilogram in those under 30 kilograms. Tocilizumab may be given by itself or in combination with methotrexate or other non-biologic drugs used to treat rheumatoid arthritis. Tocilizumab should not be given in combination with another biologic drug.
Reactions to tocilizumab infusions, including fever and chills, can occur, but these are rare. Perhaps the most concerning potential side effect with regular therapy is the increased risk of infection, as it is with most biologic therapies. The primary concern is for common bacterial infections. Unusual infections, such as tuberculosis (TB), have not been seen frequently with tocilizumab, but they do remain a concern, and screening for prior exposure to TB is recommended before starting tocilizumab therapy. Screening and monitoring for TB and other important but unusual infections, including fungal infections, is important during treatment with tocilizumab. Overall, the rate of infection seen in clinical trials with tocilizumab was similar to that seen with other biologic drugs used in the treatment of rheumatoid arthritis. Talk to your doctor to make sure you are up to date with your vaccines.
Tocilizumab has been associated with increased cholesterol levels in some patients. After you start taking tocilizumab, your doctor will periodically do blood tests to check your cholesterol level. If your cholesterol level becomes too high, it is possible you may need to start taking a medication to lower it. Tocilizumab also can cause an increase in some liver enzymes or a decrease in the white blood cells important in fighting infections and/or platelets (important for blood clotting); all of these are measured with regular blood tests. Your doctor will check these tests after you start taking tocilizumab and may need to adjust the dose of tocilizumab or other medications you may be taking, such as methotrexate, if any of these problems occur.
Finally, a rare complication seen with tocilizumab use in clinical trials was bowel perforation, or a hole in the bowel wall. If you have a history or diverticulitis or develop abdominal pain or bloody bowel movements while taking tocilizumab, you should notify your doctor immediately.
Reviewed May 2015. Written by Eric Ruderman, MD, and John Tesser, MD, and reviewed by the American College of Rheumatology Communications and Marketing Committee. This information is provided for general education only. Individuals should consult a qualified health care provider for professional medical advice, diagnosis and treatment of a medical or health condition.
© 2015 American College of Rheumatology