What is tocilizumab and why is it prescribed?
Tocilizumab (trade name: RoActemra) is a type of drug called a biological therapy. In some conditions too much of a protein called IL-6 is produced in the body, leading to tiredness, anaemia, inflammation and damage to bones, cartilage and other tissues. Tocilizumab blocks the action of IL-6, reducing these effects.
Tocilizumab isn't a painkiller, but can modify the disease over a longer period. It may be 2–12 weeks before you notice an improvement.
Tocilizumab can be prescribed by a rheumatologist for rheumatoid arthritis or juvenile idiopathic arthritis (JIA).
It may be the first biological therapy you receive, or you may have tried others first, such as an anti-TNF drug or rituximab. It's usually prescribed in combination with methotrexate.
Are there any reasons I won't be prescribed tocilizumab?
Tocilizumab won't be started if:
Doctors sometimes use a score known as DAS28 to work out how active your arthritis is. This counts how many of 28 specific joints are tender and swollen, and looks at inflammation levels in a blood test. You'll also be asked to score how well you feel on a scale of 0 to 10.
Your doctor may decide not to prescribe you tocilizumab if you're pregnant or breastfeeding, or if you have (or have had):
- a condition such as diabetes that makes you more prone to infection
- liver disease or abnormal liver function tests
- low levels of neutrophils (white blood cells) or platelets (which help the blood to clot)
- a history of intestinal ulcers or diverticulitis
- repeated or serious infections
Before you start treatment you'll have a chest x-ray and blood tests. Your doctor will check if you’ve ever been exposed to tuberculosis (TB). You may need a course of treatment for latent (asymptomatic) TB before starting tocilizumab. You'll also be checked for previous hepatitis infection, as tocilizumab may increase the risk of hepatitis being reactivated.
You'll need further cholesterol checks and blood tests every 4–8 weeks while you're on tocilizumab to monitor its effects.