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Tocilizumab (Actemra)

What is a Tocilizumab (Actemra)?
Actemra is a drug belonging to the ‘biologics/ monoclonal antibody’ group. It blocks the Interleukin-6 receptor. Interleukin-6 is a chemical that activates multiple cells responsible for the joint inflammation in rheumatoid arthritis.
When is Actemra used in Rheumatoid arthritis?
One is advised Actemra if the disease is not controlled with the basic disease modifying agents (Methotrexate/ leflunomide/ sulphasalazine/ hydroxychloroquine) or if one does not tolerate these medicines. They are also considered if you fail to improve with anti-TNF agents.
How is Actemra given?
Actemra is given as an intravenous infusion. It is given every once every 4 weeks.
Before you take Actemra, inform your doctor about—
If you have any heart disease (angina/ heart failure/ palpitations).
If you have any ongoing infection/ have had recurrent infections.
If you are suffering from Tuberculosis.
If you have to take any vaccinations in the near future. Live vaccines cannot be taken when on Actemra therapy.
Can I plan pregnancy when on Actemra?
No. The safety of Actemra in pregnancy is not proven. Do not plan pregnancy when on Actemra. Actemra crosses the placenta & can harm your unborn baby.
Can I breast feed my baby when on Actemra?
No. Actemra is secreted in breast milk & can harm your baby.
What are the side effects of Actemra?
Infusion reaction- A few patients do experience infusion reactions in the form of chills, shivering, fever, headache, difficulty in breathing.
Patients on Actemra are at a higher risk of infection as it suppresses the immunity.
Occurrences of abnormal lipid levels have been seen in patients on Actemra. The same would be monitored closely by your Rheumatologist.
Cardiac abnormalities have been seen in some patients on Actemra. The same would be monitored closely by your Rheumatologist.
Decrease in the total white cell count & an increase in the liver enzymes has been seen in some patients.
How useful is Actemra in Rheumatoid arthritis?
Clinical trials have shown a significant improvement in joint pain/ swelling of rheumatoid arthritis with Actemra 1,

1)Smolen J, Beaulieu A, Rubbert-Roth A, et al. Effect of interleukin-6 receptor inhibition with tocilizumab in patients with rheumatoid arthritis (OPTION study): a double-blind, placebo-controlled, randomised trial. Lancet. 2008;371(9617):987–97
2) Jones G et al Comparison of tocilizumab monotherapy versus methotrexate monotherapy in patients with moderate to severe rheumatoid arthritis: The AMBITION study. Ann Rheum Dis. 2009 Mar 17 epub.

Clinical trials of Actemra

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Created on: April 2007
Last updated on: Feb 2015
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