Tocilizumab Patient Monitoring and Management
Ongoing monitoring of your patient is important during the treatment of a chronic disease. Some biologic agents used in the treatment of Rheumatoid Arthritis have guidelines for the management of changes in laboratory values. Tocilizumab patients should be monitored for changes in neutrophils, platelets, lipids, and hepatic transaminases, as changes in these parameters were associated with treatment with Tocilizumab. Dosage modifications may be required.
Hold tocilizumab treatment if a patient develops a serious infection until the infection is controlled.
Lipids should be monitored 4-8 weeks after initiation of tocilizumab and then at 6 month intervals.
Manage patients according to the clinical guidelines for hyperlipidemia.
Liver enzymes should be monitored 4-8 weeks after initiation of tocilizumab for the first 6 months of treatment and then every 3 months.
Liver Enzymes >1 to 3x ULN: For persistent increases in this range reduce the frequency of tocilizumab injection to every 2 weeks or hold the dose until liver enzymes normalized. Can then resume tocilizumab 162 mg SC every 2 weeks and increase frequency as clinically indicated. For IV patients reduce the dose to 4 mg/kg or hold tocilizumab until liver enzymes have normalized.
Liver Enzymes >3 to 5x ULN: Hold tocilizumab until liver enzymes less than 3 times ULN then follow recommendations above.
Liver Enzymes >5x ULN: Discontinue tocilizumab
Neutrophils should be monitored 4-8 weeks after initiation of tocilizumab for the first 6 months of treatment and then every 3 months.
ANC > 1000: Maintain tocilizumab dosing
ANC from 500 - 1000: Hold tocilizumab. Once ANC is above 1000, resume tocilizumab 162 mg SC every 2 weeks and increase frequency as clinically indicated. For IV patients resume tocilizumab at 4 mg/kg and increase to 8 mg/kg as appropriate.
ANC < 500: Discontinue tocilizumab
Platelets should be monitored 4-8 weeks after initiation of tocilizumab for the first 6 months of treatment and then every 3 months.
Platelets 50,000 to 100,000: Hold tocilizumab. Once platelets are above 100,000, resume tocilizumab 162 mg SC every 2 weeks and increase frequency as clinically indicated. For IV patients resume tocilizumab at 4 mg/kg and increase to 8 mg/kg as appropriate.
Platelets < 50,000: Discontinue tocilizumab