Is subcutaneous injection of Actemra safe and effective in rheumatoid arthritis patients?

This study examined the safety and effectiveness of switching from intravenous tocilizumab (Actemra) to subcutaneous.

Tocilizumab is a drug which prevents the immune system from attacking the joints in rheumatoid arthritis patients. It is given intravenously (injected into a vein by a healthcare professional) once a month. It might also be effective if given to patients subcutaneously (under the skin) every 2 weeks. When given subcutaneously, the patient may be able to administer it themselves.

This study aimed to determine the safety and effectiveness of switching from intravenous to subcutaneous tocilizumab. This study involved 329 RA patients divided into two groups. One group received subcutaneous tocilizumab (162 mg every 2 weeks) for 24 weeks. This group continued to receive subcutaneous tocilizumab for an additional 84 weeks. The other group received intravenous tocilizumab (8 mg/kg once a month) for 24 weeks, followed by subcutaneous tocilizumab for 84 weeks. The effectiveness and safety were assessed 12 weeks after switching. 

The number of patients in remission (no signs and symptoms of disease) was similar in both groups. 62.5% of patients in the group that switched and 50% of the patients that  only received subcutaneous tocilizumab  achieved remission. However, patients with a high body weight (> 70 kg) had a lower blood concentration of tocilizumab when they switched to subcutaneous. The safety profiles were similar in both groups. Some patients receiving the subcutaneous injections had mild injection site reactions. 

This study concluded that subcutaneous tocilizumab is safe and effective. However, the effectiveness may be lower in patients with a high body weight.

The safety and effectiveness of switching was only assessed after 12 weeks. It might have been ideal to look at the long-term safety and effectiveness by extending the study period. This study received funding from Chugai Pharmaceuticals who developed tocilizumab. 

Consult your physician regarding the methods of tocilizumab delivery available.