Monitoring en management tocilizumab GCA
Active tuberculosis, which may present with pulmonary or extrapulmonary disease. Patients should be tested for latent tuberculosis before ACTEMRA use and during therapy. Treatment for latent infection should be initiated prior to ACTEMRA use
Neutropenia: Treatment with ACTEMRA was associated with a higher incidence of neutropenia. It is not recommended to initiate ACTEMRA treatment in patients with a low neutrophil count i.e., absolute neutrophil count (ANC) less than 2000 per mm3. In patients who develop an ANC less than 500 per mm3 treatment is not recommended.
Thrombocytopenia: Treatment with ACTEMRA was associated with a reduction in platelet counts. It is not recommended to initiate ACTEMRA in patients with a platelet count below 100,000 per mm3. In patients who develop a platelet count less than 50,000 per mm3, treatment is not recommended.
Elevated Liver Enzymes: It is not recommended to initiate ACTEMRA treatment in patients with elevated transaminases ALT or AST >1.5x ULN. In patients who develop elevated ALT or AST >5x ULN, treatment is not recommended.
Lipid Abnormalities: Treatment with ACTEMRA was associated with increases in lipid parameters such as total cholesterol, triglycerides, LDL cholesterols, and/or HDL cholesterol.
Liver Enzyme Abnormalities:
Lab Value Recommendation Greater than 1 to 3x ULN
reduce injection frequency to every other week or hold dosing until ALT or AST have normalized.
Resume ACTEMRA at every other week and increase frequency to every week as clinically appropriate.
Greater than 3 to 5x ULN (confirmed by repeat testing)
Hold ACTEMRA dosing until less than 3x ULN and follow recommendations above for greater than 1 to 3x ULN
For persistent increases greater than 3x ULN, discontinue ACTEMRA
Greater than 5x ULN
Low Absolute Neutrophil Count (ANC) Lab Value (cells per mm3 )
ANC greater than 1000 Maintain dose ANC 500 to 1000
Hold ACTEMRA dosing When ANC greater than 1000 cells per mm3 : resume ACTEMRA at every other week and increase frequency to every week as clinically appropriate
ANC less than 500
Low Platelet Count Lab Value (cells per mm3 )
50,000 to 100,000 Hold ACTEMRA dosing
When platelet count is greater than 100,000 cells per mm3 : resume ACTEMRA at every other week and increase frequency to every week as clinically appropriate Less than 50,000 Discontinue ACTEMRA