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), 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. This has to be done in a healthcare setting.

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. 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 on tocilizumab, although these types of infections have not been frequently seen. Allergic reactions to intravenous tocilizumab infusions can occur but these are rare. Tocilizumab has been associated with increased cholesterol levels in some patients and should be periodically monitored. If your cholesterol level becomes too high, it is possible you may need to start taking a medication to lower it. 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 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, or if you plan on getting any live vaccinations. Live vaccines contain a milder form of the virus or bacteria to help your body develop an immune response without you developing symptoms of the disease it is intended to prevent. These vaccines always carry a small chance a person could get the infection from the vaccine. Live vaccines include the nasal spray flu vaccine, and others such as the measles, mumps, rubella, and yellow fever vaccines.

Updated February 2023 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.

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