was assessed in ﬁve random- closely if new infection devel-
Once-monthly ized, double-blind studies ops; discontinue if serious or
treatment in patients >18 years with opportunistic infection or
active RA.Tocilizumab was sepsis develops. Monitor lipids
for arthritis given every four weeks as four to eight weeks after ini-
monotherapy (Study I), in tiation, then every six months.
Product: Actemra combination with metho- Immunosuppression. Central
Company: Genentech trexate (MTX) (Studies II nervous system demyelinat-
Pharmacologic class: and III) or other DMARDs ing disorders. Malignancies.
Interleukin-6 (IL-6) recep- (Study IV) in patients with Elderly. Pregnancy (Cat.
tor inhibitor an inadequate response to The FDA has approved Actemra only
C). Nursing mothers: not
Active ingredient: those drugs, or in combina- for relatively severe disease. recommended.
Tocilizumab 20 mg/mL; tion with MTX in patients Interactions: Increased risk
solution for IV infusion with an inadequate response aspartate transaminase (ALT/ for infection with concomi-
after dilution; preservative- to TNF antagonists (Study AST) >1.5 upper limit tant immunosuppressants (e.g.,
free. V).The primary end- of normal (ULN). Reduce TNF antagonists, IL-1R
Indication: Moderately to point was the proportion dose to 4 mg/kg if elevated antagonists, anti-CD20 mono-
severely active rheumatoid of patients who achieved liver enzymes, neutropenia, or clonal antibodies, selective co-
arthritis (RA) in patients an American College of thrombocytopenia occur (see stimulation modulators).Avoid
who have had an inadequate Rheumatology (ACR) 20 literature). live vaccines. Caution with
response to one or more response at Week 24. In Children: Not CYP3A4 substrate drugs (e.g.,
tumor necrosis factor (TNF) all studies, patients treated recommended. oral contra