2 years and older who have not responded adequately to
NSAIDs, systemic corticosteroids and methotrexate, if the
manufacturer makes tocilizumab available with the
discount agreed as part of the patient access scheme.
Tocilizumab isnotrecommended for the treatment of
systemic juvenile idiopathic arthritis in children whose
disease continues to respond to methotrexate or who have
not been treated with methotrexate.
Patients currently receiving tocilizumab for systemic
juvenile idiopathic arthritis who do not meet these criteria
should have the option to continue treatment until it is
considered appropriate to stop.
http://www.nice.org.uk/guidance/ta238
▶Abatacept, adalimumab, etanercept and tocilizumab for
treating juvenile idiopathic arthritis (December 2015 )
NICE TA373
Tocilizumab is recommended as an option for treatment of
polyarticular juvenile idiopathic arthritis (JIA), including
polyarticular‑onset, polyarticular‑course and extended
oligoarticular JIA in children 2 years and older whose
disease has responded inadequately to previous therapy
with methotrexate and if the manufacturer provides
tocilizumab with the discounts agreed in the patient
access schemes.
http://www.nice.org.uk/guidance/ta373
lMEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug.
Solution for injection
▶RoActemra(Roche Products Ltd)
Tocilizumab 180 mg per 1 mlRoActemra 162 mg/ 0. 9 ml solution for
injection pre-filled syringes| 4 pre-filled disposable injectionP
£ 913. 12 (Hospital only)
RoActemra 162 mg/ 0. 9 ml solution for injection pre-filled pen| 4 pre-
filled disposable injectionP£ 913. 12
Solution for infusion
ELECTROLYTES:May contain Sodium
▶RoActemra(Roche Products Ltd)
Tocilizumab 20 mg per 1 mlRoActemra 400 mg/ 20 ml concentrate
for solution for infusion vials| 1 vialP£ 512. 00 (Hospital only)
RoActemra 200 mg/ 10 ml concentrate for solution for infusion vials|
1 vialP£ 256. 00 (Hospital only)
RoActemra 80 mg/ 4 ml concentrate for solution for infusion vials|
1 vialP£ 102. 40 (Hospital only)
IMMUNOSUPPRESSANTS›T-CELL ACTIVATION
INHIBITORS
Abatacept 01-Dec-2017
lINDICATIONS AND DOSE
Moderate-to-severe active polyarticular juvenile
idiopathic arthritis (specialist use only)
▶BY INTRAVENOUS INFUSION
▶Child 6–17 years (body-weight up to 75 kg): 10 mg/kg every
2 weeks for 3 doses, then 10 mg/kg every 4 weeks,
review treatment if no response within 6 months
▶Child 6–17 years (body-weight 75–100 kg): 750 mg every
2 weeks for 3 doses, then 750 mg every 4 weeks, review
treatment if no response within 6 months
▶Child 6–17 years (body-weight 101 kg and above): 1 g every
2 weeks for 3 doses, then 1 g every 4 weeks, review
treatment if no response within 6 monthslCONTRA-INDICATIONSSevere infection
lCAUTIONSChildren should be brought up to date with
current immunisation schedule before initiating therapy.
do not initiate until active infections are controlled.
predisposition to infection (screen for latent tuberculosis
and viral hepatitis).progressive multifocal
leucoencephalopathy (discontinue treatment if
neurological symptoms present)
lINTERACTIONS→Appendix 1 : abatacept
lSIDE-EFFECTS
▶Common or very commonAsthenia.cough.diarrhoea.
dizziness.gastrointestinal discomfort.headaches.
hypertension.increased risk of infection.nausea.oral
ulceration.skin reactions.vomiting
▶UncommonAlopecia.anxiety.arrhythmias.arthralgia.
bruising tendency.conjunctivitis.depression.dry eye.
dyspnoea.gastritis.hyperhidrosis.hypotension.
influenza like illness.leucopenia.menstrual cycle
irregularities.pain in extremity.palpitations.
paraesthesia.respiratory disorders.sepsis.sleep disorders
.throat tightness.thrombocytopenia.vasculitis.
vasodilation.vertigo.visual acuity decreased.weight
increased
▶Rare or very rarePelvic inflammatory disease.respiratory
malignancy
lCONCEPTION AND CONTRACEPTIONEffective
contraception required during treatment and for 14 weeks
after last dose.
lPREGNANCYManufacturer advises avoid unless essential.
lBREAST FEEDINGPresent in milk inanimalstudies—
manufacturer advises avoid breast-feeding during
treatment and for 14 weeks after last dose.
lDIRECTIONS FOR ADMINISTRATIONForintravenous
infusion, given intermittentlyinSodium chloride 0. 9 %;
reconstitute each vial with 10 mL water for injections using
the silicone-free syringe provided; dilute requisite dose in
Sodium Chloride 0. 9 %to 100 mL (using the same silicone-
free syringe); give over 30 minutes through a low protein-
bindingfilter (pore size 0. 2 – 1. 2 micron).
lNATIONAL FUNDING/ACCESS DECISIONS
NICE decisions
▶Abatacept, adalimumab, etanercept and tocilizumab for
treating juvenile idiopathic arthritis (December 2015 )
NICE TA373
Abatacept is recommended as options for treating
polyarticular juvenile idiopathic arthritis (JIA), including
polyarticular‑onset, polyarticular‑course and extended
oligoarticular JIA in patients 6 years and older whose
disease has responded inadequately to other
disease‑modifying anti‑rheumatic drugs (DMARDs)
including at least 1 tumour necrosis factor (TNF) inhibitor,
onlyif the manufacturer provides abatacept with the
discounts agreed in the patient access schemes.
http://www.nice.org.uk/TA373lMEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug.
Solution for injection
▶Orencia(Bristol-Myers Squibb Pharmaceuticals Ltd)
Abatacept 125 mg per 1 mlOrencia 125 mg/ 1 ml solution for
injection pre-filled syringes| 4 pre-filled disposable injectionP
£ 1 , 209. 60 (Hospital only)
▶Orencia ClickJect(Bristol-Myers Squibb Pharmaceuticals Ltd)
Abatacept 125 mg per 1 mlOrencia ClickJect 125 mg/ 1 ml solution for
injection pre-filled pen| 4 pre-filled disposable injectionP
£ 1 , 209. 60
Powder for solution for infusion
ELECTROLYTES:May contain Sodium
▶Orencia(Bristol-Myers Squibb Pharmaceuticals Ltd)
Abatacept 250 mgOrencia 250 mg powder for concentrate for
solution for infusion vials| 1 vialP£ 302. 40 (Hospital only)BNFC 2018 – 2019 Arthritis 641
Musculoskeletal system10