Actemra issues

Anyone else having issues with the Actemra (Tocilizumab) wearing off before the next infusion?

I am finding that my infusions hold for around 3 weeks. Then the pain, stiffness and fatigue set in hard! My bloodwork shows absolutely nothing for inflammation which i am thankful for as my c reactive protein reading were between 119 and 157 for an entire year. Actemra has brought it down to below 0.2mg/l.

Anyhow, my knees, feet and hips have felt like I have hot fireplace pokers stuck in them when i move around for the past week. My next infussion is march 30, and the Infusion of the drug really kicks my butt for 3 days afterword then i get to be pain free for 2 1/2 - 3 weeks.

Is it supposed to wear off? My rheumy does not think so as I am the only patient to report this issue to him.

My background, athlete, was very physically fit before becoming ill, usual heart rate pre illness was 58 at rest then went up to over 100 for almost a year., now it is back to 54-58 and bp at 90/60. I am 43, 190# and fatigued as all get out.

Thank you for reading, if you can recommend something that may bring my energy levels up, please forward them to me.


12 Replies

  • Hi Scott. I have been on actemra infusions for approx. 3 years now and have always had the same problem. All in all it is probably 2 & half weeks of feeling good before I start to feel so tired and can feel myself slowing down. A lot of people on this medication find the same thing but I still think it's worth it. Do you take any other meds? I still have to take methotrexate and 5mg prednisolone daily! Make sure you take the time to rest for a couple of days following the infusion. Good Luck

  • I only take the Actemra. I was on prednisone for over a year and got off it as it made me quite agitated. Metho made me very ill as well.

    And i cannot find a pain med that actually works.

    Thank you for confirming what i am going through

  • Hi scott

    I was experiencing the same "wearing off too soon " of my enbrel . I take an injection once a week . So my rheumatologist upped my dose to 2X per week. He ran interference for me when the insurance initially refused to pay for double the medication and the acquiesced . I am feeling A difference hopefully I keep going in the right direction.

    I live in America how is it in England

    Hope this helps best Tytymama

  • I am actually in Vancouver Canada.

    I a d my rheumatologist arw looking at a dosage change or a time change, like every 3 weeks instead of 4. He too will do the fighting with insurance to get it covered.

  • Hi

    I have read this before re biologics " wearing off" too soon. I was told they don't build up in your body the way that dmards do. I am on weekly injections of abatacept and feel some difference the day before it's due. I think toc can be administered by injection also, perhaps weekly? This might be a better solution for you?

    As for the fatigue! It's horrid isn't it? Might be worth just asking your GP to test your b12 levels and iron levels, see if there's anything that can be treated, but seems to me fatigue is part and parcel of RA and to some extent we have to manage it. I guess I'm fortunate in that I feel pretty good during the day, but once it gets past 8pm I'm just exhausted and thinking of my bed! Doesn't make for much of a social life does it?

  • I am thinking about infusion every 3 weeks instead, but my rheumy will make tbat decision. Also will have to fight with insurance company for coverage.

    B12 are good, Iron still too high from GP injecting and then not following up on blood work numbers.

    I am the same way with fatigue, however i am exhausted all day. I can sleep for 2 hours or 10 hours and wake feeling the same way. And no, bed does not make for a healthy social life.

  • Well I hope they agree to a 3 weekly infusion for you if that would suit you better. Are you in the US? Things are different in the uk so we don't have to worry about the moment anyway!

    I used to be just exhausted all day before we got things under control. I would do one small thing like put a wash on, then need to go and sit down! When I managed to get back into work I just longed for home time and the sofa! Perhaps when you get things under better control some of that fatigue will lift? It has for me, I'm fine most of the day and can do all my normal "stuff", it's just the evenings that are a bit of a wash out 😟.

  • Forgot to add, have you also had your thyroid levels checked? I have an underactive thyroid as well.....another auto immune issue that I've had for years. I take daily thyroxine for that and my levels are kept ok, but when that first started I was tired all day too.

  • Are they giving you the right dose? Actemra is one of those biologics were the amount you receive depends on your weight, i.e. 4mg per Kg then 8mg per Kg depending on how you are doing. I live in France and have been through several biologics, all of which stop working after a couple of years, I had to stop taking Actemra because I suddenly had an allergic reaction to it. Now on Rituximab (Mabthera) which is given by infusion every 6 mths.

    I was originally on a high dose of codeine for the pain, but that stopped working! Now taking Zaldiar (Tramadol/paracetamol) for pain - works great but don't drive if I've taken some.

  • KayEP

    The actemra dosage is correct, however, they are looking into adjusting it. I have yet to find a pain med that actually works. Tramadol gives me a major headache, codeine does not work, acetaminophen does not work, ibuprofen / naproxen does not work. Trying to have the infusion every 3 weeks to prevent the 3rd week crash on the actemra.


    I am in BC Canada. I have had pretty much every test that the british columbia medical services plan does. I have had gallium scans, PET scans, ct and mri's. Thyroid function is good, liver and kidneys are good, heart is good.

    Infusion was yesterday, so waiting for a few days before it takes affect.


  • The infusion was 2 weeks ago now, and i have had very little relief. I have also noticed that when i am at the gym and i do a leg workout, instead of a two day recovery time, it is more like a week and a half before my legs feel like they can do anything. Kinda weird. I am on a doctor recommend rehab program with a trainer to try and gain back some of the muscle i lost a year and half ago. I have not been able to increase above body weight for over 7 months now. My upper body on thebother hand has a quick recovery time and is building nicely. Come on legs!!!

  • I have noticed something tonight.

    Since starting Actemra in December, i have noticed my feet and hands becoming quite painfully cold and difficult to warm up. My wife noticed tonight that my toenails have gone a blueish color and that my feet are unusually cold to the touch. Has anyone else run into this issue and how did you rectify it?

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