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Tocilizumab: Brands, Price & Uses in Bangladesh
Tocilizumab is a recombinant humanized monoclonal antibody that blocks the interleukin-6 (IL-6) receptor.
About Tocilizumab
Indications of Tocilizumab
Tocilizumab is a recombinant humanized monoclonal antibody that blocks the interleukin-6 (IL-6) receptor. It is used for the following indications:
Established / approved uses
- Rheumatoid arthritis (RA): Moderately to severely active RA in adults who have had an inadequate response to one or more disease-modifying antirheumatic drugs (DMARDs), typically used in combination with methotrexate or as monotherapy.
- Polyarticular juvenile idiopathic arthritis (PJIA): Active PJIA in patients 2 years of age and older.
- Systemic juvenile idiopathic arthritis (SJIA): Active SJIA in patients 2 years of age and older.
- Giant cell arteritis (GCA): Treatment of adults with giant cell arteritis, usually combined with a tapering glucocorticoid course.
- Cytokine release syndrome (CRS): Severe or life-threatening CRS associated with chimeric antigen receptor (CAR) T-cell therapy, in patients 2 years and older.
- COVID-19: Hospitalized adults and children 2 years and older who are receiving systemic corticosteroids and require supplemental oxygen, non-invasive or invasive mechanical ventilation, or extracorporeal membrane oxygenation (ECMO) — used as an adjunct to standard of care, not as monotherapy.
Guideline-supported / adjunct use
- Systemic sclerosis-associated interstitial lung disease (SSc-ILD): To slow the rate of decline in pulmonary function in adults.
Because Tocilizumab is a biologic agent with a boxed warning for serious infection, it should be prescribed and monitored only by a physician experienced in its use.
Dosage & Administration of Tocilizumab
Tocilizumab dosing depends on the indication, route of administration (intravenous or subcutaneous), and patient body weight. Treatment should be initiated and supervised by a physician experienced in diagnosing and treating the relevant condition.
| Indication | Route | Dose |
|---|---|---|
| Rheumatoid arthritis (adult) | IV infusion | 4 mg/kg every 4 weeks, may increase to 8 mg/kg based on clinical response (max 800 mg/infusion); infused over 60 minutes |
| Rheumatoid arthritis (adult) | Subcutaneous | 162 mg once weekly (body weight ≥100 kg) or once every other week (body weight <100 kg), adjusted by response |
| Giant cell arteritis (adult) | Subcutaneous | 162 mg once weekly, typically with a tapering glucocorticoid course |
| Polyarticular JIA (≥2 yrs) | IV infusion | Weight-based: 10 mg/kg (<30 kg) or 8 mg/kg (≥30 kg) every 4 weeks |
| Systemic JIA (≥2 yrs) | IV infusion | Weight-based: 12 mg/kg (<30 kg) or 8 mg/kg (≥30 kg) every 2 weeks |
| Cytokine release syndrome (≥2 yrs) | IV infusion | 8 mg/kg (≥30 kg) or 12 mg/kg (<30 kg) as a single dose, infused over 1 hour; up to 3 additional doses may be given if inadequate response, at least 8 hours apart (max 4 doses total) |
| COVID-19 (hospitalized, ≥2 yrs) | IV infusion | 8 mg/kg (≥30 kg) or 12 mg/kg (<30 kg) as a single dose (max 800 mg); a second dose may be given if clinical signs/symptoms worsen or fail to improve, at least 8 hours after the first |
Doses should be administered by a healthcare professional. Baseline and periodic laboratory monitoring (complete blood count, liver function tests, lipid profile) is required before and during treatment, and dose adjustments or temporary interruption may be needed based on laboratory abnormalities. See Precautions and Warnings for monitoring requirements.
Side Effects of Tocilizumab
The most commonly reported adverse effects of Tocilizumab (occurring in ≥5% of patients) include:
- Upper respiratory tract infections and nasopharyngitis
- Headache
- Hypertension
- Elevated liver transaminases (ALT/AST)
- Injection site reactions (with subcutaneous use)
- Increased blood cholesterol and triglycerides
Less common but serious effects
- Serious infections (bacterial, fungal, viral, opportunistic, including tuberculosis reactivation) — see Precautions and Warnings
- Gastrointestinal perforation, especially in patients with a history of diverticulitis
- Neutropenia and thrombocytopenia
- Hepatotoxicity, including rare severe drug-induced liver injury
- Infusion-related or injection-site hypersensitivity reactions, including rare anaphylaxis
Contraindications of Tocilizumab
Tocilizumab is contraindicated in patients with:
- Known hypersensitivity to tocilizumab or any component of the formulation.
- Active, severe infection (including active tuberculosis or other serious systemic infections) — therapy should not be initiated until the infection is controlled.
Frequently Asked Questions about Tocilizumab
What is Tocilizumab used for?
Tocilizumab is used to treat rheumatoid arthritis, juvenile idiopathic arthritis, giant cell arteritis, cytokine release syndrome from CAR T-cell therapy, and, in certain hospitalized patients, COVID-19 requiring oxygen or ventilatory support.
How is Tocilizumab given?
Tocilizumab is given either as an intravenous infusion over about 60 minutes in a clinic or hospital setting, or as a subcutaneous injection that may be self-administered after training, depending on the indication and formulation prescribed.
What are the main risks of Tocilizumab?
Tocilizumab carries a boxed warning for serious, potentially fatal infections, including tuberculosis reactivation and fungal or bacterial infections. It can also raise liver enzymes and cholesterol levels, lower blood counts, and rarely cause gastrointestinal perforation, particularly in people with a history of diverticulitis.
Can Tocilizumab be used during pregnancy?
Tocilizumab should be used during pregnancy only if the potential benefit clearly justifies the potential risk to the fetus, based on animal data suggesting possible harm; any use during pregnancy should be under close physician supervision.
Do I need tests before starting Tocilizumab?
Yes. Before starting Tocilizumab, your doctor will typically screen for latent tuberculosis and viral hepatitis, and check baseline blood counts, liver function, and a lipid profile, repeating these periodically during treatment.
Can I receive vaccines while on Tocilizumab?
Live or live-attenuated vaccines should be avoided while on Tocilizumab because it suppresses parts of the immune system; make sure all routine vaccinations are up to date before starting therapy, and discuss any vaccine needs with your physician.
Disclaimer
The information provided is accurate to the best of our knowledge, but it does not replace professional medical advice. We cannot guarantee its completeness or accuracy, and the absence of specific information about a drug should not be taken as an endorsement. We are not responsible for any consequences arising from this information, so please consult a healthcare professional for any concerns or questions.