Tocilizumab (Actemra)

Tocilizumab (brand name Actemra) is a monoclonal antibody that blocks interleukin-6 (IL-6), an inflammatory signaling molecule. It's approved for giant cell arteritis (GCA) and is used off-label for some patients with NMO.

How It Works

IL-6 is a key driver of inflammation in conditions like GCA. By blocking IL-6, tocilizumab reduces the inflammatory process. It also allows faster tapering of steroids.

Common Uses

• Giant cell arteritis—FDA approved
• NMO—off-label
• Rheumatoid arthritis

Administration

• Subcutaneous injection weekly (GCA)
• Or IV infusion monthly
• Self-injection possible after training

Side Effects

Common

• Injection site reactions
• Upper respiratory infections
• Headache
• Elevated liver enzymes
• Elevated cholesterol

Serious

• Serious infections
• GI perforation (rare)
• Liver damage
• Allergic reactions

Important Warning

Monitoring

• Liver function tests
• Lipid panel
• Complete blood count
• Watch for infections
• TB screening before starting

Benefits in GCA

• Can taper steroids faster (reducing steroid side effects)
• Reduces risk of GCA flares
• Long-term steroid-sparing

Frequently Asked Questions

Can I stop steroids?

Tocilizumab allows faster steroid tapering but usually doesn't replace steroids entirely, at least initially. Many patients can eventually stop steroids or use very low doses.

Will I still need ESR/CRP monitoring?

Those tests will be low on tocilizumab even if GCA is active, so they're less useful for monitoring. Clinical symptoms become more important.

How long will I need this?

Duration varies. Some patients can stop after 1-2 years if GCA is in remission; others need longer treatment.