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Actemra
Actemra (generic name: tocilizumab) is a biologic medication used to treat various inflammatory conditions, including rheumatoid arthritis (RA), systemic juvenile idiopathic arthritis (SJIA), and giant cell arteritis (GCA). It is also used in hospitalized patients with severe COVID-19 to reduce inflammation. Actemra works by inhibiting the activity of interleukin-6 (IL-6), a protein involved in the immune system that contributes to inflammation in these diseases. Reducing IL-6 activity helps decrease inflammation, relieve symptoms, and prevent joint damage in autoimmune diseases.
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Frequently Asked Questions
How long does it take for Actemra to start working?
Patients may start noticing improvements in symptoms such as joint pain and swelling within 2 to 6 weeks of starting Actemra. However, full benefits may take longer.
Can Actemra cure rheumatoid arthritis?
Actemra does not cure rheumatoid arthritis, but it helps manage the symptoms and slow disease progression. Long-term treatment may be necessary to control symptoms.
What should I do if I miss a dose of Actemra?
If you miss a dose, take it as soon as you remember, unless it is close to the time for your next dose. Do not take extra medicine to make up for the missed dose. Contact your healthcare provider for specific guidance.
Can I receive vaccines while on Actemra?
Live vaccines should be avoided while taking Actemra. Inactivated vaccines, such as the flu shot, are generally considered safe, but always discuss vaccinations with your healthcare provider before receiving any immunizations.
Is Actemra safe for long-term use?
Actemra has been shown to be safe for long-term use in clinical trials, but regular monitoring by your healthcare provider is necessary to ensure the medication remains safe and effective for your condition.
Comprehensive Drug Guide
How Does Actemra Work?
Actemra works by blocking interleukin-6 (IL-6), a cytokine that plays a key role in the body's immune and inflammatory response. IL-6 is involved in many processes that lead to inflammation and tissue damage in autoimmune diseases like rheumatoid arthritis. By inhibiting IL-6, Actemra helps reduce inflammation, pain, swelling, and joint damage, while also slowing disease progression.
Common Dosages
- Intravenous infusion: 80 mg/4 mL, 200 mg/10 mL, and 400 mg/20 mL
- Subcutaneous injection: 162 mg/0.9 mL pre-filled syringes or pens
Typical Dosing
- For rheumatoid arthritis (RA): The usual starting dose for IV infusion is 4 mg/kg every four weeks, which may be increased to 8 mg/kg based on response. The subcutaneous dose is 162 mg once every week.
- For systemic juvenile idiopathic arthritis (SJIA): The IV dose is 12 mg/kg for patients weighing less than 30 kg or 8 mg/kg for those weighing 30 kg or more, every two weeks.
- For giant cell arteritis (GCA): The subcutaneous dose is 162 mg every week or every other week, depending on the patient's response.
Typical Dosing
FDA Approved Indications
- Moderate to severe rheumatoid arthritis (RA) in adults who have not responded to other treatments.
- Systemic juvenile idiopathic arthritis (SJIA) in children 2 years of age and older.
- Polyarticular juvenile idiopathic arthritis (PJIA) in children 2 years of age and older.
- Giant cell arteritis (GCA) in adults.
- Severe COVID-19 in hospitalized adults and children aged 2 years and older, to reduce inflammation and improve outcomes.
Who Shouldn't Take Actemra?
- Active infections: Use is contraindicated in patients with serious or untreated infections, including tuberculosis.
- Known hypersensitivity to tocilizumab or any other component of the formulation.
Advice From The Pharmacist
- Actemra can increase the risk of infections, including serious bacterial, viral, or fungal infections. Notify your healthcare provider if you develop symptoms of infection, such as fever, cough, or unusual fatigue.
- Regular blood tests are necessary to monitor for potential side effects, such as liver enzyme elevations or changes in blood cell counts.
- Ensure you receive all recommended vaccines before starting treatment, as live vaccines should not be administered during Actemra therapy.
- For patients self-administering the subcutaneous injection, it is important to rotate injection sites between the abdomen, thigh, or upper arm to prevent irritation.
Side Effects of Actemra
Common Side Effects
- Upper respiratory tract infections
- Headache
- Increased liver enzymes (ALT/AST)
- Hypertension
- Injection site reactions (for subcutaneous form)
Uncommon/Severe Side Effects
- Severe allergic reactions (anaphylaxis)
- Increased risk of serious infections, including tuberculosis, fungal infections, and sepsis
- Liver damage
- Gastrointestinal perforations (rare but serious)
Risks and Warnings of Actemra
- Infection Risk: Actemra suppresses the immune system, making patients more susceptible to infections. It is important to notify your healthcare provider if you develop symptoms of an infection or have been exposed to contagious diseases like tuberculosis.
- Liver Toxicity: Actemra can cause elevated liver enzymes, and patients should have their liver function monitored regularly during treatment.
- Gastrointestinal Risks: Rare cases of gastrointestinal perforation have been reported, especially in patients with diverticulitis or other risk factors.
Interactions with Actemra
Common Drug Interactions
- Immunosuppressants: Using Actemra with other immunosuppressive medications may increase the risk of infections.
- Live vaccines: Live vaccines should be avoided during Actemra treatment, as the medication may reduce the body's immune response to the vaccine, increasing the risk of infection.
- Warfarin: Patients on warfarin may require closer monitoring of their INR levels, as Actemra can potentially affect blood clotting.
Alternatives to Actemra
- Humira (adalimumab): Another biologic used to treat rheumatoid arthritis, juvenile idiopathic arthritis, and other autoimmune conditions.
- Enbrel (etanercept): A tumor necrosis factor (TNF) inhibitor used for rheumatoid arthritis and other inflammatory conditions.
- Xeljanz (tofacitinib): An oral Janus kinase (JAK) inhibitor used to treat rheumatoid arthritis and other autoimmune diseases.
- Methotrexate: A traditional disease-modifying antirheumatic drug (DMARD) often used in combination with biologics for rheumatoid arthritis.
