Actemra (tocilizumab)

What it is: A biological therapy. In rheumatoid arthritis, too much of the protein IL-6 may be produced, causing tiredness, anaemia, inflammation, and damage to bones, cartilage, and soft tissues; tocilizumab blocks IL-6. It is not a painkiller — it modifies the disease over a longer period, and improvement may take 2–12 weeks. It is prescribed for rheumatoid arthritis or juvenile idiopathic arthritis (JIA), and may be the first biologic tried, or used after an anti-TNF or rituximab. It is usually prescribed with methotrexate.

Before starting: It is not started if your arthritis isn't active, you have an infection, or fewer than two DMARDs (e.g. methotrexate, hydroxychloroquine) have been tried first. It may not be prescribed if you are pregnant or breastfeeding, or if you have infection-prone conditions (e.g. diabetes), liver disease or abnormal liver tests, low neutrophils or platelets, a history of intestinal ulcers or diverticulitis, repeated or serious infections, or cancer. A chest x-ray and blood tests are done before starting, plus a TB check (latent TB may need treatment) and hepatitis screening. Cholesterol checks and blood tests are done every 4–8 weeks during treatment.

How it's taken: Either an IV infusion (about 1 hour, every 4 weeks) in our infusion suite, or a weekly injection under the skin at home with a pre-filled syringe. You can switch from infusion to injections — start the injections when the next infusion is due. It is a long-term treatment; keep taking it even if it is slow to work, and even when you improve.

Side effects: Most common (usually not serious): cough or sore throat, blocked or runny nose, headache, dizziness, mouth ulcers, conjunctivitis, high blood pressure, weight gain or swollen ankles, skin rashes, infections or itching, stomach irritation or abdominal pain, and drip-site inflammation. Infection risk is increased and infections are harder to spot — report a sore throat, fever, or bruising, bleeding, or paleness promptly; stop and see a doctor if severe. Chickenpox and shingles can be severe. Tocilizumab can raise cholesterol (which may need GP treatment) and affect liver tests, white cells, and platelets — you may occasionally miss infusions, and rarely must stop. With intestinal ulcers or diverticulitis there is a higher infection risk and a possibility of bowel perforation — report stomach pain with fever, or bowel-habit changes such as passing blood, immediately. Long-term effects are not fully understood, as it is a relatively new drug; there may be a slightly increased cancer risk, which is unconfirmed.

Pregnancy: The effect on the unborn baby is unknown; tocilizumab doesn't cross the placenta until 16 weeks, so it is unlikely to be harmful if you are exposed early in pregnancy. Women of childbearing age should use contraception during treatment and for 3 months after. If you are also on methotrexate, use contraception for 3 months after stopping it. Don't breastfeed on tocilizumab — it is unknown whether it passes into milk.

Why the checks: The monitoring follows IL-6’s fingerprints: neutrophil and platelet counts and liver tests are checked because blocking IL-6 can lower counts and raise enzymes; lipids are followed because cholesterol commonly rises; TB and hepatitis screening come first because immune-pathway blockade can reactivate dormant infections; and the CRP caveat — explained above — changes how everyone interprets your bloods while you are on it.

Used for Rheumatoid arthritis