Tocilizumab

Tocilizumab is used to treat inflammatory types of arthritis, such as rheumatoid arthritis (RA).

For RA, tocilizumab may be used as monotherapy or in combination with DMARD therapy, such as methotrexate (MTX).

Tocilizumab is given by infusion once a month or by subcutaneous (s.c.) injection (meaning in the fatty layer of tissue just under the skin) once every one to two weeks.

When given by infusion the dose of tocilizumab depends on your body weight. The starting dose is 4 mg/kg, which can be increased up to 8 mg/kg if an adequate response is not achieved. The medication comes in a single-use vial for administration by infusion. Each infusion takes about 60 minutes.

When given by injection the dose of tocilizumab is 162 mg. If you weigh less than 100 kg you will require an injection every two weeks, followed by an increase to every week based on clinical response. If you weigh 100 kg or more, you will require an injection every week. The medication comes in single-use pre-filled syringes for administration by injection.

Tocilizumab pre-filled syringes cannot be used for infusions and the vial for infusions cannot be used for injection.

In some people with arthritis, a signalling protein called interleukin-6 (IL-6) is involved in the body’s inflammatory response where it attacks the body’s own tissues. Tocilizumab works by blocking the IL-6 receptor so that IL-6 cannot bind and cause inflammation. By doing this, tocilizumab can help to reduce pain and swelling in the joints, improve day-to-day function, and prevent long term damage to the joints.

As with all of the biologics, you may not feel the effects of the tocilizumab right away. Some people begin to feel the effects of the medication fairly quickly; however, it may take three to six months to feel its full effect. It is important to be patient and keep taking your medication.

To provide symptom relief while you are waiting for tocilizumab to take effect, your healthcare provider may recommend taking a steroid, such as prednisone, or a non-steroidal anti-inflammatory drug (NSAID).

Tocilizumab can make it more difficult for your body to fight infections. People with active infections should not take tocilizumab. If you have a fever, think you have an infection or have been prescribed an antibiotic, contact your healthcare provider. People who have had frequent infections in the past or a history of tuberculosis should discuss the use of tocilizumab with their prescriber.

Also contact your healthcare provider if you are having surgery as you may need to stop tocilizumab until you are healed and there is no sign of infection.

Tocilizumab has not been studied in pregnant people or lactating parents so its effect(s) on pregnant people or nursing babies are unknown. You should tell your doctor if you are pregnant or are planning to become pregnant. Because of the potential for adverse reactions in nursing infants, a decision should be made on whether or not to discontinue nursing or the medication, taking into account the importance of the drug to the lactating parent.

Anyone who has had a previous allergic reaction to tocilizumab should avoid the medication.

Anyone with a history of cancer or nervous system problems, such as multiple sclerosis, should discuss the use of tocilizumab with their healthcare provider.

Before starting this medication, you will likely be tested for inactive (“latent”) tuberculosis (TB) and hepatitis B because tocilizumab can dampen the immune system and cause these infections to become active. If TB or hepatitis is found, it will need to be treated before you start tocilizumab.

Ideally, your vaccinations should be up to date prior to starting tocilizumab. If you have already started therapy with tocilizumab, your healthcare provider will likely recommend most inactive vaccines (e.g., influenza, pneumococcal). Live vaccines are not recommended due to risk of causing infection. Before receiving any vaccinations while taking tocilizumab, you should speak with your healthcare provider.

Like all medications, taking tocilizumab carries some risk of side effects, which must be balanced with the potential benefits. In general, the risk of joint damage and permanent disability (resulting from arthritis) is much greater than the risks of side effects from tocilizumab. When monitored properly the vast majority of side effects are rare, most improve over time and are reversible.

Tocilizumab can increase your risk of infections. You should take precautions to minimize your risk of being infected by common contagious infections such as COVID-19, influenzae, pneumonia, and the common cold.

In rare cases, tocilizumab can cause an allergic reaction during the infusion (flushing, itching, changes in heart rate and blood pressure, etc.). A healthcare provider will monitor for this reaction during the infusion. 
For people taking the medication by injection, tocilizumab can rarely cause a reaction (redness, pain, and itching) at the injection site. Talk to your healthcare provider if these symptoms become severe.

Again, in uncommon circumstances, people may experience upper respiratory tract infections (common cold, sinus infections) headaches and an increase in blood pressure with tocilizumab. Other rare side effects include cold sores, blisters and shingles. If any of these symptoms become severe, please speak with your healthcare provider. Some people have also developed skin infections (sometimes with fever and chills). If you believe you have an infection, please contact your healthcare provider.

Very rarely tocilizumab has been associated with stomach perforations (holes in the lining of the stomach), usually as a complication of diverticulitis (infection of the large intestine). This requires immediate medical attention. If you develop fever and severe stomach pain that does not go away, seek medical attention.

There have been rare cases of disorders that affect the nervous system of people taking tocilizumab. Signs that you could be experiencing a problem affecting your nervous system include numbness or tingling, problems with your vision, weakness in your legs and dizziness. If you experience these symptoms, seek medical attention.

Tocilizumab can rarely affect your blood counts, liver function and cholesterol levels. Your healthcare provider will use blood tests to monitor for these changes.

Take your tocilizumab as prescribed and contact your healthcare provider if you have any concerns while taking the medication.

If you experience an infusion reaction while taking tocilizumab, prior to your next infusion your healthcare provider may recommend a medication pre-treatment to help prevent the reaction. Your healthcare provider may also recommend a longer infusion time.

Keeping yourself well hydrated before getting your infusion and drinking while you get your infusion may also help reduce side effects.

To avoid injection reactions, injection sites should be rotated and avoid areas where the skin is tender, bruised, red and/or hard.

You will need to have your blood tested regularly while taking tocilizumab (your doctor will tell you how often). This is important to make sure tocilizumab isn’t affecting your liver, blood counts or cholesterol levels.

Tocilizumab must be refrigerated at 2 to 8 degrees Celsius and protected from light. Keep the product in the original package and out of the light.

Tocilizumab must be kept cool while travelling. Ask your pharmacist for a cool carrier if you are not able to put the drug in your refrigerator right away.

The pre-filled syringe or autoinjector must be used within 8 hours of removing from the fridge or else be discarded by returning to the pharmacy for disposal.

The patient support program for Actemra is called “Joint Effort”. Their phone number is 1-888-748-8926.