IL-6 Receptor Antagonists

Administration: Subcutaneous injection

Dose:

• Subcutaneous 200mg fortnightly
• Reduce dose to 150mg fortnightly if Neutrophils 0.5-1x10⁹/L or Platelets 50- 100x10⁹/L or ALT/AST 1-3x upper limit of normal.

Time to response: Up to 12 weeks

Indications: Rheumatoid Arthritis.

Contraindications:

• Pregnancy & breast feeding.
• Active infection including HBV & HIV.
• Active/untreated latent TB.
• ALT/AST >5X upper limit of normal.
• Neutrophils < 0.5x10⁹/l or Platelets <50x10³/μl.
• Uncontrolled hypertension or hyperlipidaemia.

Cautions:

• Diverticulitis or intestinal ulceration.

Monitoring:

• Fasting lipid profile 4-8 weeks post infusion
• FBC and LFTs every 4 weeks
• BP every 4 weeks

Vaccinations:

• Avoid live attenuated vaccines.
• Offer annual influenza vaccination.
• In those who are biologic naïve pneumococcal vaccination and Sars-Cov-2 vaccination should ideally be performed at least 2 weeks before commencing biologic treatment.
• Assuming no contraindications before starting treatment:
  • Patients >50 should undergo vaccination against HZV.
  • Those who are varicella zoster negative should be offered varicella vaccination.

In the event of:

• ALT/AST > 3x upper limit of normal – stop SARILUMAB.
• Hyperlipidaemia - treat with lipid lowering agents.
• Hypertension – treat as per SIGN 149 Guidelines.
• Infection - withhold SARILUMAB until infection treated.
• In patients with suspected complicated diverticulitis refer for urgent assessment.
• Effective contraception whilst on treatment and for 3 months after receiving SARILUMAB.
• Doses of drugs such as ATORVASTATIN, Calcium Channel Blockers, CICLOSPORIN, PHENYTOIN, Benzodiazepines, THEOPHYLLINE and WARFARIN SODIUM may need to be increased.

Administration: Subcutaneous injection or intravenous infusion

Dose:

• Subcutaneous – 162mg weekly
• IV - TOCILIZUMAB 8mg/kg given on the MDBU once very 4 weeks. The minimum dose is 480mg.

Time to response: Up to 12 weeks.

Indications:

• Rheumatoid Arthritis.
• Giant Cell Arteritis.
• Juvenile Idiopathic Arthritis.

Contraindications:

• Pregnancy & breast feeding.
• Active infection including HBV & HIV.
• Active/untreated latent TB.
• ALT/AST >5X upper limit of normal.
• Neutrophils < 0.5x10⁹/l or Platelets <50x10³/μl.
• Uncontrolled hypertension or hyperlipidaemia.

Cautions:

• Diverticulitis or intestinal ulceration.

Monitoring:

• Fasting lipid profile 4-8 weeks post infusion
• FBC and LFTs every 4 weeks
• BP every 4 weeks

Vaccinations:

• Avoid live attenuated vaccines.
• Offer annual influenza vaccination.
• In those who are biologic naïve pneumococcal vaccination and Sars-Cov-2 vaccination should ideally be performed at least 2 weeks before commencing biologic treatment.
• Assuming no contraindications before starting treatment:
  • Patients >50 should undergo vaccination against HZV.
  • Those who are varicella zoster negative should be offered varicella vaccination.

In the event of:

• Infusion reactions – will be managed on MDBU.
• ALT/AST > 3x upper limit of normal – stop TOCILIZUMAB.
• Hyperlipidaemia - treat with lipid lowering agents.
• Hypertension – treat as per SIGN 149 Guidelines.
• Infection - withhold TOCILIZUMAB until infection treated.
• In patients with suspected complicated diverticulitis refer for urgent assessment.
• Effective contraception whilst on treatment and for 6 months after receiving TOCILIZUMAB.
• Doses of drugs such as ATORVASTATIN, Calcium Channel Blockers, CICLOSPORIN, PHENYTOIN, Benzodiazepines, THEOPHYLLINE and WARFARIN SODIUM may need to be increased.