What is Tocilizumab?
Tocilizumab is an exceptional drug belonging to the family of biotherapies targeting interleukin 6 (IL-6), one of the molecules responsible for the symptoms of inflammation in autoinflammatory diseases.
It is a monoclonal antibody directed against the IL-6 receptor, which blocks its effect in the body and prevents the symptoms of inflammation (fever, pain, etc.).
Indication and dosage
Tocilizumab is approved for use in Still's disease, rheumatoid arthritis and giant cell arteritis.
It can be administered:
-either as a monthly intravenous infusion
-weekly subcutaneous injections
It is prescribed by your specialist doctor on an exceptional prescription. Once collected from the pharmacy, it must be kept refrigerated.
Injections can be given by the patient himself, or by a nurse at home.
Before prescribing Tocilizumab
Before starting tocilizumab, your specialist will carry out an assessment to rule out any possible contraindications, in particular progressive infections (dental or pulmonary).
You should also update your mandatory vaccinations with your GP, and get vaccinated against influenza and pneumococcus.
Advice on administering
- Remove tocilizumab from the fridge 15 to 45 minutes before injection, to bring it to room temperature.
- You can place an ice pack in a cloth on the skin for 15 minutes before injection to anesthetize the skin and 15 minutes after injection.
- Carefully disinfect the skin around the injection site.
- Inject subcutaneously: lower abdomen or thigh.
Tolerance
Tocilizumab requires monthly biological monitoring, initially to check efficacy (normalization of CRP) and tolerability (blood count, transaminases, lipid profile), then every 3 months thereafter.
Injection site reactions are virtually non-existent and painless.
Practical questions
The use of tocilizumab prevents the secretion of C-Reactive Protein (CRP), an inflammation protein, by the liver. CRP therefore remains negative on blood tests, even in the event of infection.
In the event of an infection with persistent fever > 48 hours, you should consult your GP as soon as possible to assess the situation.
It is not necessary to stop tocilizumab in the event of scaling. In the event of dental extraction or abscess, it is recommended that tocilizumab be discontinued two weeks prior to the procedure, and that antibiotic prophylaxis be offered in conjunction with the procedure. In the case of more extensive surgery, your dentist should discuss with your specialist the possibility of temporarily stopping tocilizumab.
In the event of surgery, your surgeon will need to discuss with your specialist whether to temporarily stop taking tocilizumab.
Vaccination under Tocilizumab
The only vaccines contraindicated when taking tocilizumab are live attenuated vaccines (BCG, measles, mumps, rubella (MMR), varicella, yellow fever, oral polio).
If you need to be vaccinated before traveling to tropical countries, you should inform your specialist so that tocilizumab can be temporarily suspended.
Annual influenza vaccination is strongly recommended.
Fertility, pregnancy & breastfeeding
In the absence of sufficient data, tocilizumab is not recommended during pregnancy, and effective contraception is required when treatment is initiated.
Pregnancy should therefore be planned with your specialist, with a recommended delay of 3 months between stopping tocilizumab and conception. In order to plan a pregnancy, the disease must also have been well controlled for several months.
In the absence of data, and as a precautionary measure, tocilizumab should be discontinued or not resumed during breast-feeding.
In men, tocilizumab may be continued if paternity is desired.