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/
If you have any ongoing infection/ have had recurrent
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
Cardiac abnormalities have been seen in some patients on
Actemra. The same would be monitored closely by your
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.
2) Jones G et al Comparison of tocilizumab monotherapy versus
methotrexate monotherapy in patients with moderate to severe
rheumatoid arthritis: The AMBITION study.
Rheum Dis. 2009 Mar 17 epub.
Clinical trials of