What is Tocilizumab?
•Tocizilumab (Actemra) is a biologic, a newer class of DMARD (Disease Modifying Anti-Rheumatic Drug).
•While in the class of biologics like TNF antagonists, Tocizilumab does not work in the same way is primarily used in the treatment of rheumatoid arthritis.
What is the typical dose?
•Tocilizumab is given through an intravenous infusion, with the dose based on body weight. It is given every 4 weeks.
How does Tocilizumab work?
•The immune system is made up of many different parts. By interfering with the correct part, it is possible to decrease the inflammation being caused by rheumatoid arthritis and similar diseases.
•Tocilizumab interferes with the immune system's ability to communicate between certain types of cells, thereby blocking their action and modulating the immune system's response. This decreases inflammation, reduces pain, and improves function.
What should I do if I miss a dose?
If you miss your dose, let your physician know right away to see if they can arrange a new infusion time, if appropriate to do so.
For more information about tocilizumab, or for questions that are specific to your situation, always consult your physician.
How soon will I feel the effects of Tocilizumab?
•Tocizilumab can take at least 1-3 months before starting to gain benefit.
If I start Tocilizumab, can I stop all my other DMARDs?
•Tocilizumab is the only biologic to date that can be used on its own, without methotrexate. However, whether or not you continue with other DMARDs is a decision between you and your rheumatologist.
•Keep in mind: In most instances, your rheumatologist has recommended you start a Biologic because your inflammatory arthritis has not been well controlled. It is important to try to control your disease as best as possible first, which may mean continuing all DMARDs for some time, before trying to decrease them.
What are the possible side effects of Tocilizumab?
Ways to Reduce Side Effects
•Intravenous Infusion Reactions
•If severe, the medication is stopped. However, certain medications can be given
to prevent similar reactions from re-occurring.
•Tocilizumab may increase your risk of
developing severe infections.
•Let your physician know if you are sick when you are supposed to receive your
infusion. They may discuss postponing your infusion until you are better.
Fevers and other severe illness should not be ignored. Discuss this with your
•If previously exposed to tuberculosis, Tocilizumab may increase your risk of
causing it to become active. Your rheumatologist will do a TB skin test and chest
x-ray to check if you have been exposed prior to starting Tocilizumab.
•Tocilizumab may lower your white blood
cell count or cause irritation to your liver.
•Ensure you complete regular bloodwork to monitor your blood cells and liver as
requested by your rheumatologist.
•Worse Cholesterol Levels
•Transient Increase in Blood Pressure
•Your physician will monitor your cholesterol levels with you. However, it is yet
clear if the type of cholesterol changes caused by tocilizumab increase your risk
for a heart attack or stroke.
•Your blood pressure will be monitored. If a persistent increase is noted, a
change in your treatment plan should be discussed.
•Risk of Bowel Perforation
•Let your doctor know if you have any bowel problems, particularly diverticulosis.
•Discuss vaccinations with your rheumatologist.
•Live vaccines should be given prior to starting Tocilizumab.