Tocilizumab: A biological therapy

Indication: Tocilizumab (Brand Name Actemra) specifically is a biological therapy and can be prescribed for the treatment of rheumatoid arthritis, juvenile idiopathic arthritis (JIA) or giant cell arteritis. Tocilizumab is also named atlizumab. 
In case you have RA, or another autoimmune or inflammatory condition, there may be excess IL-6 protein in your body. This may be responsible for causing inflammation as well as damage, and in children may be responsible for causing fever and rashes. Tocilizumab acts by blocking or stopping the effects of IL-6.

Dosage: The tocilizumab dosage is mainly based on the body weight so that each person's dose can be different.

How is tocilizumab taken?

This drug should be given as a drip (infusion) into the vein. The infusion usually takes 1 hour and is followed by a period of observation for a minimum 1 hour to make sure you don't have any adverse reactions. Doses of tocilizumab are recommended to be given every 4 weeks.

Possible side effects: The most commonly reported tocilizumab side effects are as follows:

• Cough
• Sore throat
• Blocked or runny nose
• Headaches or dizziness 
• Mouth ulcers
• High blood pressure
• Aching muscles
• Feeling out of breath
• Having a tight chest
• Wheezing
• High temperature 
• Weight gain
• Swollen ankles 
• Skin rashes
• Infections or itching 
• Stomach irritation
• Abdominal bread
• Increased cholesterol in the blood

Tocilizumab is responsible for increasing the probability of infections in those patients who are with rheumatoid arthritis. These include:

• Cold sores
• Shingles
• Cellulitis
• Pneumonia
• Upper respiratory tract infections

It is crucial that any infections are treated as soon as possible.

Precautions:

1. In case you have an active infection, tocilizumab shouldn't be given until the infection is completely treated.
2. The tocilizumab injection should be avoided in case you have active untreated tuberculosis (TB) or HIV (AIDS) infection as it is likely to be responsible for making these conditions worse. 
3. In case you have latent (inactive) TB, preventative anti-TB treatment will be started at least 4 weeks prior to treatment with Tocilizumab 400 mg / 20mL. The anti-TB treatment is usually taken for 9 months.
4. Hepatitis B / C infection may not necessarily exclude treatment. 
5. Because of the risks associated with infection, the following tests may be done prior to beginning treatment with this medicine: blood tests for hepatitis B and C, chest x-ray and two-step Tuberculin Skin, Test (Mantoux) or QuantiFERON blood test for TB, and HIV tests are required for those who are at risk of this infection.
6. Individuals with diverticular disease should not be treated with this drug as it may be responsible for increasing the risk of perforations.

When tocilizumab should not be given:

You won't be given tocilizumab 200 mg in case:

• your arthritis isn't active
• you have a severe infection. 
• you haven't tried any other treatments for your condition. 
• you're pregnant or breastfeeding.

Other drugs with Tocilizumab:

Tocilizumab 200 mg / 4mL may be used with the other arthritis drugs including:

• DMARDs such as methotrexate
• Steroid drugs such as prednisolone or cortisone injections into the joint. 
• NSAIDs such as ibuprofen (Brufen) or naproxen (Naprosyn). 
• pain drugs such as paracetamol.

Use in pregnancy and when breastfeeding: Not enough is known regarding the possible effects of tocilizumab 200 mg on the unborn baby. In case you plan to become pregnant it is crucial to discuss this with your healthcare team as each case is different. You should avoid breastfeeding while taking tocilizumab.

How to store tocilizumab:

Tocilizumab should be stored in a cool, dry place, away from direct heat as well as light. All medications need to be placed out of the reach of infants/children.

Tocilizumab Cost: The tocilizumab price may vary from non branded to branded drugs. Price for a vial of 1 injection of Actemra 200 mg is around 20436 INR. 

Important points to remember: 

1. While on tocilizumab you need to see your rheumatologist on the regular basis in order to make sure the treatment is working and minimise any possible adverse reactions.
2. If you stop Tocilizumab 80 mg/4mL or other strength for any reason you need to contact your healthcare practitioner.
3. In case you are worried about any adverse reactions you should contact your rheumatologist right away.
4. It is necessary to tell your healthcare practitioner in case you have had cancer or if you develop cancer while you are getting Actemra treatment. 

NOTE: The information provided in this article is only for informational purposes and is not served as a substitute for the medical treatment, consultation, diagnosis, of a qualified healthcare practitioner.