Tocilizumab for arthritis

Sounds like 'TOE-si-LIZ-ue-mab'

Tocilizumab is used to treat moderate-to-severe forms of rheumatoid arthritis and giant cell arteritis. Find out how to take it safely and the possible side effects. Tocilizumab is also called Actemra.

Type of medicine Also called
  • Biologics for arthritis
  • Biological disease modifying antirheumatic drugs (bDMARDs)
  • Actemra®

What is tocilizumab?

  • Tocilizumab is used to treat moderate-to-severe forms of rheumatoid arthritis, usually only after other medications have not worked. It can reduce joint pain and swelling.
  • It can also be used to treat giant cell arteritis.
  • Tocilizumab belongs to a group of medicines known as biologic medicines. These are medicines that target specific chemicals in your body involved in the inflammatory response that causes arthritis. 
  • For rheumatoid arthritis, other examples of biologic medicines used include upadacitinib (Rinvoq), rituximab and tumour necrosis factor (TNF) inhibitors (eg, adalimumab, etanercept and infliximab).
  • Tocilizumab is also used to treat COVID-19. Read more about tocilizumab for COVID-19.

How is tocilizumab given?

Tocilizumab can be given as:

  • A slow injection into a vein in your arm, once every 4 weeks. This technique is also known as an intravenous infusion, and it usually takes an hour. It is done in hospital.
  • An injection under your skin once weekly. This technique is also known as a subcutaneous injection. The injection can be given in the thigh, abdomen or upper arm and the site of injection should be rotated for each injection. Do not inject into moles or scars or an area that is bruised, red, hard or tender.

Your doctor will decide what dose is right for you, based on your body weight. For most people, tocilizumab will work within 3–6 months. You may feel better as early as 2 weeks after starting treatment.

Precautions before starting tocilizumab

Before starting tocilizumab, tell your doctor if you:

  • have hepatitis B
  • have any other conditions including tuberculosis, diverticular disease, stomach ulcers, diabetes, cancer, or raised blood pressure
  • have any problems with the way your kidneys or liver work
  • are pregnant, breast-feeding or planning to have a baby
  • are taking any other medicines including over-the-counter and complementary medicines, eg, vitamins, minerals, herbal or naturopathic medicines.

Sometimes a medicine isn’t suitable for a person with certain conditions, or it can only be used with extra care.

Monitoring and investigations

Tocilizumab can cause serious side effects, including the increased risk of infection. So before prescribing tocilizumab, your doctor will test for infections such as hepatitis and tuberculosis. They will also check your blood pressure and check how well your liver is working.

While you are on this treatment, your doctor will order blood tests to monitor the safety of tocilizumab and to see how well it is working. 

Possible side effects

Like all medicines, tocilizumab can cause side effects, although not everyone gets them. Often side effects improve as your body gets used to the new medicine.

Side effects What should I do?
  • During an intravenous infusion, you may experience low blood pressure, where you feel faint or dizzy. Your blood pressure will be monitored when you have the infusion and for a short while after
  • Let your nurse know if you feel very faint or dizzy. 
  • Allergic reaction such as a skin rash, itching, swelling of your lips, face and mouth or difficulty breathing
  • If you are in hospital when you have your dose, you will be monitored closely for these side effects. If you are at home tell your doctor immediately or ring Healthline on 0800 611 116.
  • Pain, inflammation and itching at the injection site
  • These usually are mild but if they bother you let your doctor know. For subcutaneous injections, remember to rotate the site of injection.
  • Flu-like symptoms such as fever, chills, shivering, a runny nose or sneezing 
  • Headache
  • You may experience these symptoms during the dose or anytime up to 2 weeks after having your dose.
  • Contact your doctor if these side effects are bothering you.  
  • Problems with your tummy (stomach) such as tummy pain, cramps, dark-coloured stools (poo), bleeding, fever or changes in your bowel habits such as constipation 
  • Tell your doctor immediately or ring Healthline on 0800 611 116.
  • Signs of an infections such as fever, cough, sore throat, diarrhoea (runny poo) or generally feeling weak and unwell 
  • Tell your doctor immediately or ring Healthline on 0800 611 116.
  • Signs of liver problems such as tiredness or less energy than usual, dark coloured urine, yellow skin and eyes
  • Tell your doctor immediately or ring Healthline on 0800 611 116.
For more information on side effects, see the Medsafe consumer information leaflet Actemra.

Did you know that you can report a medicine side effect to the Centre for Adverse Reactions Monitoring (CARM)? Report a side effect to a product.

Learn more

The following links have more information on tocilizumab.
Actemra
Medsafe Consumer Information Sheet, NZ
Tocilizumab Australian Rheumatology Association, Australia
Tocilizumab Rheuminfo, US

References

  1. Tocilizumab NZ Formulary, NZ
  2. Actemra data sheet, Medsafe, NZ
  3. Biologic medicines for the treatment of inflammatory conditions – what does primary care need to know? BPAC, NZ, 2013
  4. Tocilizumab – supply issue. Pharmac, NZ, 2021

Useful resources for healthcare professionals

Credits: Sandra Ponen, Pharmacist. Reviewed By: Maya, Pharmacist, Auckland Last reviewed: 11 Mar 2022