SubQ Tocilizumab Just as Safe and Effective as IV

McLaughlin M, Östör's  A. Safety of subcutaneous versus intravenous tocilizumab in combination with traditional disease-modifying antirheumatic drugs in patients with rheumatoid arthritis.Expert Opin Drug Saf. 2015;Jan 2:1-9. [Epub ahead of print]

The newer, injectable form of tocilizumab (Actemra) appears to be just as safe and effective as the original intravenous version for treating rheumatoid arthritis (RA) unresponsive to other therapies, according to an expert review from Britain.

The main drawback to the subcutaneous version of tocilizumab (TCZ) is a higher frequency of injection site reactions but these are generally mild and short-lived, say the two reviewers, both rheumatologists from the Cambridge University School of Clinical Medicine.

Advantages to the subcutaneous version of TCZ include lower cost and that patients can inject themselves at home.

The most serious concerns are the risks for infection and gastrointestinal perforations, so the reviewers advise using either form of TCZ “cautiously in patients with diverticular disease or a history of intestinal ulceration.” 

“With careful patient selection, the benefit-risk ratio is favorable, offering patients a rapid and sustained reduction in disease activity, improved function and reduced structural damage,” the review concludes.

TCZ has been shown efficacious in clinical trials and in routine clinical practice for patients whose RA does not respond to conventional DMARDs and tumor necrosis factor-alpha (TNFα) blockers.

Both versions of TCZ, a humanized anti-IL-6 receptor monoclonal antibody, are approved for use in RA either as monotherapy or in combination with conventional non-biological DMARDs such as methotrexate.