Actemra

A while ago I did a series of medicine blogs, all of which were medicines that I had tried in the past.  I've seen a few people asking about information about other medicines, and are having trouble finding information on search engines.  So, I've decided to do a few more medicine blogs about those I have left out.  Hope these help you all who have had some trouble finding information! 

Medicine Blog #7: Actemra

As I said, I've never taken Actemra before so I have no personal information about it.  I have done extensive research and compiled all that I could find here for you, to hopefully help those who are wondering about it.  There isn't a lot of information out there, because Actemra is a very new medicine on the market.  It was approved by the FDA on January 11, 2010 and on April 15, 2011 it was approved by the FDA to be taken in combination with Methotrexate. 

First, What is Acetmra, and how exactly does it work?  This was taken directly from Acetmra's website: ACTEMRA works by being specifically designed to block the action of the IL-6 messenger cytokine, and is the only medicine to do so. Cytokines send signals to white blood cells to fight germs and viruses. Unfortunately, people with RA have too many cytokines in their body, including IL-6. The white blood cells then work too hard and attack the body, resulting in the signs and symptoms of RA.

So Actemra works by getting rid of the extra cytokines, unlike Enbrel and Humira which block TNF (tumor-necrosis factor - the substance that creates inflammation) or Methotrexate which blocks white blood cells from growing too quickly (please view my other medicine blogs for more information).  It is usually given after any of these, or other medications have not worked. 

A study was done with patients who suffer from severe Rheumatoid Arthritis.  Some were given 8mg/kg and others were given 4mg/kg every 4 weeks.  59% of those who took the 8mg/kg and 48% of those who took the 4mg/kg showed 20% improvement in a number of swollen and tender joints and the CRP number was lowered after 24 weeks.  Another study was done on patients who took Actemra in combination with Methotrexate.  Those results showed that patients who were on 8mg/kg of Actemra plus Methotrexate: 56% showed 20% improvement, 36% showed 50% improvement and 20% showed 70% improvement after 52 weeks (1 year). 

How is Actemra given?  It is given intravenously (IV) by a nurse or doctor in a medical office or hospital.  The medicine takes about 1 hour to receive, and is usually given once every 4 weeks. The doasge is either 4mg/kg or 8mg/kg, depending on the severity and what other medications the patients are on.   

It is important to discuss all current medications (including supplements) with your doctor before starting Actemra, as some medications may interact with it.  Some of those medications include: blood thinners, aspirin or other NSAIDs (ibuprofen like Advil or Motrin), naproxen, some cholesterol-lowering medications, and oral contraceptives.  This isn't an entire listing, so please make sure you have a full list if everything you are currently taking for medications!

What side effects can occur with Actemra?  Side effects may include, but are not limited to:  headaches, runny nose and/or sneezing that don't go away, hives, itching, swelling of the eyes, face, lips, tongue, throat, arms, hands, feet, ankles, or lower legs, difficulty breathing or swallowing, dizziness or fainting, change in bowl movements/habits, unusual bleeding or bruising. 
As I said, these are not all possible side effects, and it is important to contact your doctor with any sign of something going on. 

Why is Chemotherapy used to treat RA, and Why are we told to ignore the side effects?

Thank you Tracie from RA Chicks for asking this question.  I know it blows my friends and families mind when they hear I'm on chemo, and say "do you have cancer now?!"  I then have to explain the best I can that no I don't have cancer, chemo is used to treat RA also.  Taking the chemo comes with severe side effects, and we are usually told to "ignore" or live through them if they are helping our joints.  I decided it was a good time to do research into how and why chemotherapy works with rheumatoid arthritis.

It may sound alarming, but a number of chemotherapy drugs are used to treat rheumatoid arthritis, usually in lower doses than when used to treat cancer.  RA is an autoimmune disease in which an abnormal immune reaction causes the inflammation of the joints. When used to treat cancer, chemotherapy drugs are given to kill off tumor cells, but in cases of RA the drugs are given to slow cell reproduction and decrease the metabolic processes that can lead to the inflammation.

The chemotherapy drugs most often used to treat rheumatoid arthritis include methotrexate, Imuran, and cytoxan. Some of the same side effects can occur as occur during cancer treatment, but they are usually not as severe because the drugs are prescribed at lower doses. 

Some of the less severe side effects of chemotherapy include: Acne; chills and fever; dizziness; flushing; general body discomfort; hair loss; headache; infertility; irregular periods; itching; loss of appetite; lowered resistance to infection; miscarriage; nausea; sensitivity to sunlight; sore throat; speech impairment; stomach pain; swelling of the breast; unusual tiredness; vaginal discharge; vomiting.

Severe side effects include: Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); black or bloody stools; blood in the urine; bone pain; calf pain/swelling; change in amount of urine; chest pain; confusion; dark urine; diarrhea; dry cough; enlarged glands; fatigue; fever or chills; inflammation of the pancreas (stomach tenderness, nausea, vomiting, fever, increased pulse rate); irregular heartbeat; mental changes; mouth sores; muscle weakness; persistent sore throat; red, swollen, or blistered skin; seizures; serious infection (herpes, hepatitis, blood infection); trouble breathing; unusual bleeding or bruising; unusual pain and discoloration of the skin; vision changes; vomit that looks like coffee grounds; yellowing of skin or eyes.

I am currently on Methotrexate and am experiencing hair loss and low energy.  These are common side effects, and we are given vitamins and are told to live through these minor side effects.  Why are we told to ignore the side effects?! Obviously if you are experiencing anything bring it up to your doctor, so he/she can make sure there isn't an underlying cause or it doesn't get worse. 

After doing research into this, I couldn't find too much, but from experience I know RA is very difficult to treat.  If they find a medicine that seems to be working very well (no pain, inflammation or signs of the RA), it's a good sign.  If the side effects are minimal and livable, in a way, they are worth it.  I know I'd rather live with thin hair or a day of feeling nauseous than weeks and weeks of not being able to move or function in life. 

Overall, there is no cure for RA and for now we learn to live with the medications that do work for us.  If side effects become so bad they are not livable, than you should not be on that medicine anymore.  ANY side effect should be mentioned to your doctor, no matter how minor.  You could wake up with a rash one morning, ignore it, and a week later having difficulty breathing.  Never let anything go without being mentioned, your doctor will not mind, I promise!  If he does, than maybe it's time to find a new doctor! I wish everyone the best of luck and hope you all find medicines that work well for you, without too much side effects.