Tocilizumab (Actemra): Uses, Side Effects

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 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.

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.

You should notify your doctor if you:

  • Develop symptoms of an infection, such as a fever or cough;
  • Think you are having any side effects, especially abdominal pain, bloody bowel movements, or allergic reactions;
  • Become pregnant, are planning pregnancy, or if you are breastfeeding;
  • are planning to have surgery or plan to get any live vaccinations.

Keyword: tocilizumab.

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