Tocilizumab (Actemra)
Actemra (Tocilizumab) is a biologic medicine that suppresses an overactive immune system in order to treat rheumatoid arthritis, giant-cell arteritis and some types of juvenile arthritis.
Actemra works by blocking a receptor on the surface of cells that’s related to the body’s immune response: the interleukin-6 receptor (IL-6R).
This medication is often given in combination with methotrexate.
It can take 6-12 weeks to feel the effects of Actemra.
Taking Actemra
Actemra is available as an injection (Actemra SC) and as an intravenous infusion (Actemra IV). The injection can be done quickly at home. The infusion is done every 4 weeks at a specialized infusion clinic.
The normal dose for the injection is 162 mg, every 1 or 2 weeks depending on body weight.
Watch our video to learn how inject Actemra at home:
Learn how to inject subcutaneous injectionsLearn how to inject autoinjectorsSubcutaneous injections (under the skin injections) are easy to do compared to other types of injections. A small needle pokes just under the skin to deliver medicine into the “fatty tissue” below.
The dose for Actemra IV infusions is based on the patient’s weight, either at 4 mg/kg or 8 mg/kg. Therefore typical doses range from 200 mg to a maximum of 800 mg per infusion.
The manufacturer of Actemra offers a support program to Canadian patients that are prescribed the medication:
Patient support program enrolment formsImportant Tests and Risks
Actemra can make it a bit harder for people to fight off infections. People taking Actemra should call their doctor they have a fever, think they have an infection, or have been prescribed antibiotics to treat an infection.
It’s important to coordinate with doctors and stop treatment before any surgery. It can be re-started once things have healed and there’s no sign of infection.
Patients should discuss all vaccinations with their doctor because some (live vaccines) are not advisable to get while taking Actemra.
It’s important to get a Tuberculosis (Tb) skin test and a chest x-ray before starting Actemra.
Regular blood testing is important while taking Actemra to make sure that the medication isn’t affecting the liver, blood counts, or cholesterol levels. Follow a blood testing schedule recommended by your doctor.
Science
Actemra works by blocking the interleukin-6 receptor (IL-6R) found on the surface of cells within the body. Interleukin-6 (IL-6) is a signalling protein, or cytokine, that plays an important role in immune response.
Interleukin-6 is secreted by the immune system’s white blood cells, including T-cells and macrophages, to stimulate an immune response. They might release interleukin-6 during an infection, or after an injury that damages tissue, and the release leads to inflammation.
Some patients with vasculitis and arthritis might have abnormally high interleukin-6 levels. This can cause pain and swelling in the joints and the blood vessels.
Actemra is a type of protein called a monoclonal antibody that blocks interleukin-6 from working. In blocking interleukin-6, Actemra suppresses the body’s immune system. Although this suppression can make it slightly harder for patients to fight off infections, it also helps to stabilize an overactive immune system.
Safety
Actemra (tocilizumab) can cause headaches or pain/redness/swelling at the injection site. People taking this medication should call their doctor if these symptoms persist or get worse.
Actemra can rarely cause an allergic reaction during an infusion.
Actemra has rarely been associated with an injury to the bowel (holes in the wall of the bowel). Patients should tell their doctor if they develop stomach pain during treatment with this medicine.
Patients have very rarely developed conditions of the nervous system while taking Actemra.
People that should NOT be taking Actemra include:
- Anyone who has had a previous serious allergic reaction to Actemra
- Pregnant women, women who are planning on becoming pregnant in the near future, women who are currently breastfeeding
- People with an active infection (such as tuberculosis)
- Possibly people who have cancer or have had a past history of certain cancers.
People taking Actemra that are about to have surgery should discuss stopping the medication with their doctor.
Learn more about pregnancy and medications:
Pregnancy and medicationsPeople taking Actemra should call their doctor if they feel sick and want to stop, or if they are concerned about any side effects.
Other reasons for people taking Actemra to call a doctor include:
- Fever or possible infection
- Upcoming surgery
- Becoming pregnant
- Before getting any vaccinations
- Developing a rash
- Developing stomach pain
Actemra Video
Watch rheumatologist Dr. Andy Thompson introduce Actemra in a short 3-minute video:
Resources
DIN
- 02350092 (IV)
- 02350106 (IV)
- 02350114 (IV)
- 02424770 (SC)