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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.
For adults with RA, tocilizumab can be given as an intravenous infusion (injected directly into the vein) every four weeks followed by an increased dose every four weeks; for GCA, it is given once every week as a subcutaneous injection, an injection under the skin. For children with PJIA, it is given once every four weeks as an intravenous infusion or once every two - three weeks as a subcutaneous injection depending on weight. For children with SJIA, it is given once every two weeks as an intravenous infusion. When used as a subcutaneous injection, the medicine can be injected into the arm, 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.
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.
You should notify your doctor 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. Notify your doctor if you become pregnant, are planning pregnancy, or if you are breastfeeding. Be sure to talk with your doctor if you are planning to have surgery or if you plan to get any live vaccinations; these include the shingles vaccine, the nasal spray flu vaccine, and others such as the measles, mumps, rubella, and yellow fever vaccines.
Updated June 2018 by Elizabeth Roth-Wojcicki, RN,MS APNR 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.