What is RoActemra/ tocilizumab?
RoActemra is one of the most recent biologic drugs to be licensed for rheumatoid arthritis (RA) patients. It blocks the effects of a cytokine* called interleukin-6 (IL-6).
What is IL-6?
IL-6 is one of the main causes of inflammation and joint damage in RA, as well as contributing to the fatigue and anaemia that many patients suffer.
How is RoActemra different to the other biologics currently available for RA?
There are now several biologics used to treat RA. The first to be developed were the anti-TNFs (Remicade, Enbrel, Humira and, most recently, Cimzia and Simponi). These block another important cytokine, TNF, which also causes inflammation and joint damage.
Other biologic drugs include Mabthera, which kills B-cells and Orencia, which targets T-cells, two important cell types in RA. RoActemra therefore targets a different aspect of the immune response in RA than other biologic drugs.
Why are so many different biologics needed?
RA is a complex disease and no two patients are exactly the same, largely because of the different genes they inherit. An important consequence is that patients respond in different ways to anti-RA drugs. For example, some patients gain huge benefit from anti-TNF drugs, whereas others derive very little benefit. Also, some patients lose responsiveness to effective treatments over time. Therefore it is very important to have a number of treatment options available.
How will I know which is the best treatment for me?
At the moment you cannot know for certain and you may need to try several drugs until you find the one that is best for you. The way in which your rheumatologist can use these drugs is also guided by the National Institute for Health and Care Excellence (NICE). In the future it should become possible to match the best drug to each patient, by using blood tests or DNA tests, so-called 'personalised' medicine.
Is RoActemra safe?
No drug is completely safe but RoActemra has passed through an extensive development programme, and so a lot is known about its safety. As with any immunosuppressive drug there is a slight risk of infection and before starting RoActemra you will be asked about infections, past and present. You may also be tested for tuberculosis, if you have not been tested recently. RoActemra can occasionally cause your white blood cells or platelets to fall, and your liver tests or cholesterol to rise. In the trials this did not cause any complications and most patients continued to receive the drug. However, you will have blood tests checked from time to time (usually every 4-8 weeks initially) and you may need to take a drug to reduce your cholesterol. Because RoActemra is new it is possible that other side-effects will become apparent with time.
Can anyone take RoActemra?
You shouldn’t receive RoActemra if you currently have an infection, liver problems or blood abnormalities that involve your white cells or platelets. You should also tell your doctor if you have had diverticulitis because this condition can rarely be exacerbated by RoActemra. You also should not receive it if you are pregnant or planning to become pregnant. Your rheumatologist may require you to have stopped other biologics for a period of time before starting RoActemra. If you have had an allergic reaction to other antibody therapies then you should remind your rheumatologist of this.
Why has my doctor prescribed RoActemra?
You will be prescribed RoActemra if your RA has not been adequately controlled by at least two standard disease-modifying drugs such as methotrexate, sulphasalazine or leflunomide, and if your disease activity score (DAS) is above 5.1. You may also have received one or more biologics before being prescribed RoActemra, though this is not necessary under current NICE guidelines.
How do I take RoActemra?
RoActemra is administered either by weekly injection under the skin or by monthly infusion (drip). The infusion takes an hour, and is normally given at the hospital where you receive your rheumatology care.
Can I receive RoActemra with other therapies?
Yes. Although RoActemra is often given alongside methotrexate, it can work well without. If you are already taking methotrexate this will usually be continued.
What should I expect after I start treatment with RoActemra?
Many patients start to feel a benefit within 2 weeks of their first infusion although it can take longer. In some patients the benefits increase with time and so you may feel better after each infusion. In addition to feeling less pain in your joints you may also notice an improvement in tiredness and feel able to do more.
RoActemra is a new biologic that works in a different way to those currently available. It is effective against both joint symptoms and fatigue and tends to work quickly. As with all immunosuppressive drugs it slightly increases the chance of infection and it is very important that you report any unusual symptoms whilst receiving this new therapy.
*Cytokines are substances released by the body during inflammation.
References available on request
Professor John Isaacs MBBS,BSc, PhD, FRCP, Freeman Hospital, Newcastle
Original article: 05/01/2010
Next review due: 02/02/2018