Tocilizumab (Actemra)

Tocilizumab (Actemra) is a biologic medication approved to treat adults with moderately to severely active rheumatoid (RA), adults with giant cell arteritis (GCA), adults with systemic sclerosis complicated by interstitial lung disease, and people ages 2 and above with polyarticular juvenile idiopathic arthritis (PJIA) or systemic juvenile idiopathic arthritis (SJIA). Tocilizumab blocks the inflammatory protein IL-6, which improves joint pain and swelling from arthritis and other symptoms caused by inflammation.

How To Take It

Tocilizumab can be administered either as an injection under the skin or as an intravenous infusion. When it is injected under the skin, it can be used every week or every other week, usually given in the skin of the abdomen or the thighs. When it is given as an infusion, it is given once every 4 weeks.

Some patients will start to see improvement within a few weeks, but it may take several months to take full effect. Tocilizumab may be taken alone or with methotrexate or other non-biologic drugs. Tocilizumab should not be given in combination with other biologic drugs. Blood tests will be used to monitor for increases in cholesterol or liver enzymes and for reductions in blood cell counts while taking tocilizumab.

Side Effects

Tocilizumab can compromise your immune system. It can lower your cell counts, including your white blood cell count. It increases the risk of infections, including shingles. If you develop symptoms of an infection while using this medication, you should stop using it and contact your doctor. All patients should be tested for tuberculosis before starting tocilizumab. Allergic reactions to intravenous tocilizumab infusions can occur but these are rare. Tocilizumab has been associated with increased cholesterol levels in some patients. A rare complication seen with tocilizumab use in clinical trials was bowel perforation, or a hole in the bowel wall. If you have a history or diverticulitis or develop abdominal pain or bloody bowel movements while taking tocilizumab, you should notify your doctor immediately.

Tell Your Rheumatology Provider

You should notify your rheumatology provider if you develop symptoms of an infection, such as a fever or cough, or if you think you are having any side effects, especially abdominal pain, bloody bowel movements, or allergic reactions. If you become pregnant, are planning a pregnancy, or if you are breastfeeding be sure to tell your doctor. Be sure to talk to your rheumatology provider if you are planning on having surgery, as the medication may need to be held briefly. Be sure to discuss vaccinations with your provider.

Updated February 2024 Karmela Kim Chan, MD, and reviewed by the American College of Rheumatology Communications and Marketing Committee.

This information is provided for general education only. Individuals should consult a qualified health care provider for professional medical advice, diagnosis, and treatment of a medical or health condition.