Actemra (tocilizumab) Product Information (PI) - Roche Australia

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Effects on Fertility Preclinical data do not suggest an effect on fertility under treatment with a murine analogue of tocilizumab. Effects on endocrine active organs or on organs of the reproductive system were not seen in a chronic cynomolgus monkey toxicity study, nor was reproductive performance affected in IL-6 deficient male and female mice. Use in Pregnancy - Category C ACTEMRA should not be used during pregnancy unless clearly necessary. There are no adequate data from the use of ACTEMRA in pregnant women. The potential risk for humans is unknown. Women of childbearing potential should be advised to use adequate contraception during and for several months after therapy with ACTEMRA. In an embryo-foetal toxicity study conducted in cynomolgus monkeys, a slight increase of abortion/embryo-foetal death was observed with high systemic cumulative exposure in the 10 mg/kg/day mid-dose group (> 35 times human exposure) and in the 50 mg/kg/day high-dose group (> 100 times human exposure) compared to vehicle control and lowdose groups. It cannot be excluded that this finding is related to ACTEMRA treatment. Placental transfer of both tocilizumab and anti-tocilizumab antibodies to the foetus was seen in cynomolgus monkeys. Use in Lactation It is unknown whether ACTEMRA is excreted in human breast milk and its efficacy and safety in lactating women has not been established. However, it is known that endogenous immunoglobulins of the IgG isotype are excreted into human milk. A decision on whether to continue/discontinue breast-feeding or to continue/discontinue therapy with ACTEMRA should be made taking into account the benefit of breastfeeding to the child and the benefit of ACTEMRA therapy to the woman. Transfer of a murine analogue of tocilizumab into the milk of lactating mice has been observed. Use in Children The safety and efficacy of ACTEMRA in children below 18 years of age with conditions other than pJIA and sJIA have not been established. Ten patients who participated in the pivotal study for pJIA were less than 4 years of age. Children under the age of two have not been studied. Available data only support use of ACTEMRA in children with pJIA who have had an inadequate response to or intolerance to MTX. Long-term safety data for ACTEMRA use in children with pJIA are currently limited to 2 years, and at present no comparison with the safety profile of other biological DMARDs approved for use in this indication has been made. Actemra ® PI 131004 20 of 37 CDS 8.0
Treatment with a murine analogue did not exert toxicity in juvenile mice. In particular, there was no impairment of skeletal growth, immune function and sexual maturation. Use in the Elderly Population analyses evaluated the potential effects of demographic characteristics on the pharmacokinetics of ACTEMRA in adult rheumatoid arthritis patients. Results of these analyses showed that no adjustment of the dose is necessary for age, gender, or race. No dose adjustment is required in elderly patients. Carcinogenicity A carcinogenicity study of ACTEMRA has not been conducted. Proliferating lesions were not observed in a chronic cynomolgus monkey 6-month toxicity study. Genotoxicity Standard genotoxicity studies with ACTEMRA in both prokaryotic and eukaryotic cells were negative. Effects on Laboratory Tests Caution should be exercised when considering initiation of ACTEMRA treatment in patients with a low neutrophil count. Decreases in neutrophil counts below 1 x 10 9 /L occurred in 3.4%, with counts < 0.5 x 10 9 /L occurring in 0.3%, of patients on ACTEMRA 8 mg/kg + DMARD without clear association with serious infection (see PRECAUTIONS – Haematological Abnormalities; ADVERSE EFFECTS - Laboratory Abnormalities). In patients with an absolute neutrophil count < 0.5 x 10 9 /L treatment is not recommended. Ability to Drive and Use Machines No studies on the effects on the ability to drive and use machines have been performed andthere is no evidence from the available data that ACTEMRA treatment affects the ability to drive and use machines. However, given that dizziness has been reported, patients who experience this adverse reaction should be advised not to drive or use machines until it has resolved. Systemic Juvenile Idiopathic Arthritis Macrophage activation syndrome (MAS) MAS is a serious life-threatening disorder that may develop in patients with sJIA. In clinical trials, ACTEMRA has not been studied in patients during an episode of active MAS (see ADVERSE EFFECTS). Actemra ® PI 131004 21 of 37 CDS 8.0
Page 1 and 2: ACTEMRA Tocilizumab (rch) CAS 37582
Page 3 and 4: Polyarticular Juvenile Idiopathic A
Page 5 and 6: CLINICAL TRIALS Rheumatoid Arthriti
Page 7 and 8: durable responses were seen for ove
Page 9 and 10: following 2 years of treatment (83%
Page 11 and 12: 1:1 to receive either ACTEMRA 8 mg/
Page 13 and 14: temperature recording ≥ 37.5°C i
Page 15 and 16: Systemic Juvenile Idiopathic Arthri
Page 17 and 18: Infusion Reactions). In the post-ma
Page 19: Assessment of lipid parameters shou
Page 23 and 24: of the studies was 6 months and in
Page 25 and 26: Infusion Reactions In the 6 month c
Page 27 and 28: Immunogenicity One patient in the 1
Page 29 and 30: eported in 0.3% patients receiving
Page 31 and 32: ACTEMRA in clinical trials experien
Page 33 and 34: 3 to 5 x ULN (confirmed by repeat t
Page 35 and 36: Rheumatoid Arthritis From a 100 mL
Page 37: Roche Products (New Zealand) Limite

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