What are IL-6 Antagonists?
- IL-6 Antagonists are in a family of medications called Biologics, a new class of DMARD (Disease Modifying Anti-Rheumatic Drug) which have been available for over 5 years now.
- IL-6 Antagonists are most commonly used in the treatment of inflammatory arthritis including rheumatoid arthritis. However, they have also been used to try to treat a variety of other autoimmune rheumatic conditions.
What is the typical dose of a IL-6 Antagonist?
- Tocilizumab (Actemra) – It is given either through a monthly intravenous infusion, with the dose based on body weight, or an injection under the skin weekly or every second week.
- Sarilumab (Kevzara) – It is given as an injection under the skin every second week.
How do IL-6 Antagonists work?
- The immune system is made up of many different parts. By interfering with the correct part, it is possible to decrease the inflammation being caused by rheumatoid arthritis and similar diseases.
- IL-6 Blockers interfere with the immune system’s ability to communicate between certain types of cells, thereby blocking their action and modulating the immune system’s response. This decreases inflammation, reduces pain, and improves function.
How soon will I feel the effects of IL-6 Blockers?
- IL-6 Blockers can take at least 1-3 months before starting to gain benefit.
If I start an IL-6 Blocker, can I stop all my other DMARDs?
- IL-6 Blockers may be used on its own, without methotrexate or other DMARDs. However, whether or not you continue with other DMARDs is a decision between you and your rheumatologist.
- Keep in mind: In most instances, your rheumatologist has recommended you start a Biologic because your inflammatory arthritis has not been well controlled. It is important to try to control your disease as best as possible first, which may mean continuing all DMARDs for some time, before trying to decrease them.
What are the possible side effects of Tocilizumab?
|Side Effect||Ways to Reduce Side Effects|
|Intravenous Infusion Reactions||If severe, the medication is stopped. However, certain medications can be given to prevent similar reactions from re-occurring.|
|IL-6 Blockers may increase your risk of developing severe infections.||Let your physician know if you are sick when you are supposed to receive your infusion. They may discuss postponing your infusion until you are better. Fevers and other severe illness should not be ignored. Discuss this with your doctor. |
If previously exposed to tuberculosis, IL-6 Blockers may increase your risk of causing it to become active. Your rheumatologist will do a TB skin test and chest x-ray to check if you have been exposed prior to starting an IL-6 Blocker.
|IL-6 Antagonists may lower your white blood cell count or cause irritation to your liver.||Ensure you complete regular bloodwork to monitor your blood cells and liver as requested by your rheumatologist.|
|Worse Cholesterol Levels Transient Increase in Blood Pressure||Your physician will monitor your cholesterol levels with you. However, it is not yet clear if the type of cholesterol changes caused by IL-6 Blockers increase your risk for a heart attack or stroke. |
Your blood pressure will be monitored. If a persistent increase is noted, a change in your treatment plan should be discussed.
|Risk of Bowel Perforation||Let your doctor know if you have any bowel problems, particularly diverticulitis.|
|Medication Interactions||Discuss vaccinations with your rheumatologist. |
Live vaccines should be given prior to starting IL-6 Blockers.
What should I do if I miss a dose?
- If you miss your dose, let your physician know right away to see if they can arrange a new treatment time, if appropriate to do so.
For more information about IL-6 Antagonists, or for questions that are specific to your situation, always consult your physician.