Tocilizumab (Actemra)

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Tocilizumab Update

The American College of Rheumatology (ACR) is actively engaged with the FDA Center for Drug Evaluation and Research (CDER) drug shortage team as they work with the manufacturer to resolve current shortages of tocilizumab IV, which was given emergency use authorization on June 24, 2021 to be used for the treatment of COVID-19 in some hospitalized adult and pediatric patients.

Read the press release.

Tocilizumab (Actemra) is a biologic medication currently approved to treat adults with moderately to severely active rheumatoid arthritis (RA), adults with giant cell arteritis (GCA), and children ages two and above with Polyarticular Juvenile Idiopathic Arthritis (PJIA) or Systemic Juvenile Idiopathic Arthritis (SJIA). Biologic medications are proteins designed by humans that affect the immune system. Tocilizumab blocks the inflammatory protein IL-6. This improves joint pain and swelling from arthritis and other symptoms caused by inflammation.

How to Take It

For adults with RA, tocilizumab can be given as an intravenous infusion (injected directly into the vein) every 4 weeks; for RA, if you are less than 100kg: the dose is 162mg every other week as a subcutaneous injection, an injection under the skin, and if you are greater than 100kg: the dose is 162mg every week as an injection under skin; or GCA, it is given as 162mg once every week as a subcutaneous injection, an injection under the skin; for children with PJIA, it is given once every 4 weeks as an intravenous infusion; or once every 2-3 weeks as a subcutaneous injection depending on weight. For children with SJIA, it is given once every 2 weeks as an intravenous infusion. When used as an injection under the skin, the medicine can be injected into the thigh or abdomen. The site of injection should be rotated so the same site is not used multiple times. Tocilizumab infusion or injection should not be given if an adult or child is actively ill with an illness or high fever at the time the medication is due. Some patients will start to see improvement within a few weeks, but it may take several months to take full effect. Tocilizumab may be taken alone or with methotrexate or other non-biologic drugs. Tocilizumab should not be given in combination with another biologic drug. Blood tests will be used to monitor for increases in cholesterol or liver enzymes and for reductions in blood cell counts while taking tocilizumab.

Side Effects

Tocilizumab can lower the ability of your immune system to fight infections. If you develop symptoms of an infection while using this medication, you should stop it and contact your doctor. All patients should be tested for tuberculosis before starting on tocilizumab, although these types of infections have not been frequently seen. Allergic reactions to intravenous tocilizumab infusions can occur, which can include symptoms such as fever and chills, but these are rare. Tocilizumab has been associated with increased cholesterol levels in some patients, and should be periodically monitored. If your cholesterol level becomes too high, it is possible you may need to start taking a medication to lower it. 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.

Tell Your Rheumatology Provider

You should notify your rheumatology provider if you develop symptoms of an infection, such as a fever or cough, or if you think you are having any side effects, especially abdominal pain, bloody bowel movements, or allergic reactions. If you become pregnant, are planning pregnancy, or if you are breastfeeding be sure to tell your doctor. Be sure to talk to your rheumatology provider if you are planning on having surgery, or if you plan on getting any live vaccinations. Live vaccines contain a milder form of the virus or bacteria to help your body develop an immune response without you developing symptoms of the disease it is intended to prevent. These vaccines always carry a small chance a person could get the infection from the vaccine. Live vaccines include, the nasal spray flu vaccine, and others such as the measles, mumps, rubella, and yellow fever vaccines.

Updated December 2020 by Senada Arabelovic, DO, and reviewed by the American College of Rheumatology Committee on Communications and Marketing.

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.

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