Tocilizumab (Actemra®) is a type of biologic medication that has been recommended by the World Health Organisation as a treatment for patients seriously ill from COVID-19. With the growing need for effective COVID-19 treatments worldwide, demand is currently outstripping supply.
Tocilizumab is not currently used to treat COVID-19 in Australia, but it is used here to treat:
- Rheumatoid arthritis
- Polyarticular juvenile idiopathic arthritis
- Systemic juvenile idiopathic arthritis
- Giant cell arteritis
- Cytokine release syndrome
It can normally be given by IV infusion in a hospital or infusion centre or injected subcutaneously using a pre-filled syringe or pre-filled auto-injector pen. However, shortages of all tocilizumab dosages and devices now mean affected patients need to urgently review their treatment options with their prescriber.
Alternative Treatment Options for Tocilizumab
Supplies of intravenous tocilizumab are expected to vary until January 2022. There will also be up to six weeks where the subcutaneous tocilizumab devices will be out of stock at patient level.
On 4 August 2021, the Therapeutic Goods Administration (TGA) published a joint statement with the Australian Rheumatology Association and Arthritis Australia providing clinical guidelines to help health professionals manage this shortage. These guidelines outline several alternative treatment options for patients and prescribers to consider,
If you (or someone you provide care for) uses tocilizumab, you should contact your prescriber (usually your rheumatologist) as soon as possible for further guidance on managing treatment during the shortage. It is not recommended that you change any aspect of your tocilizumab treatment without consulting your treating doctor first.
The options you discuss may include:
- Delaying the start of your treatment if you have not used tocilizumab before
- Using a different type of biologic medication to treat your condition
- Reducing the frequency of your tocilizumab dose
- Using a pre-filled syringe instead of a pre-filled auto-injector pen or vice versa (as they are the same medication and strength)
Your pharmacist can substitute a different subcutaneous injection device without the need for a new prescription from now until 31 December 2021 (subject to change). Both your prescriber and your pharmacist should ensure you know how to use both the pre-filled syringe and pre-filled auto-injector pen in case they need to be switched.
If you currently receive tocilizumab via infusion, the appropriate hospital staff can use other strengths of tocilizumab to make up your usual dose.
With these alternative treatment options available, you and your rheumatologist can devise a plan that works for you. You can also consider additional medications or complementary therapies to help you manage your condition as well as possible during the supply shortage.