Tocilizumab
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Tocilizumab can be used in pregnancy if advised by a specialist. Babies exposed in the womb after the first trimester might be offered some of their vaccinations later than usual.
What is it?
Tocilizumab (RoActemra®, Tyenne®) is an antibody therapy used to treat rheumatoid arthritis and severe COVID-19. Tocilizumab is also used to treat giant cell arteritis, but this tends to affect people over 50 years old and so is very rare in pregnancy.
Benefits
What are the benefits of using tocilizumab in pregnancy?
Tocilizumab reduces inflammation in rheumatoid arthritis by stopping your immune system from attacking your body’s tissues. This is important to reduce unpleasant symptoms and prevent long-term joint damage. Tocilizumab may also lower the chance of some pregnancy problems linked to uncontrolled inflammation, including miscarriage and lower infant birth weight.
Tocilizumab can help people who are in hospital with severe COVID-19 to recover more quickly.
Risks
What are the risks of using tocilizumab in pregnancy?
Tocilizumab does not cross the placenta in the first trimester so will not directly affect your baby’s development. Only around 50 women using tocilizumab in later pregnancy have been studied. No problems were identified but further research is ideally required.
Tocilizumab used in later pregnancy can affect the baby’s immune system for several months after birth. Live vaccines should be avoided during this time. This means that the baby will not be offered vaccination against rotavirus (as this needs to be completed by four months of age) and is unlikely to be offered the BCG vaccine (if required) until they are at least six months old. A doctor will be able to advise about the best time for your baby to be given any live vaccinations.
Alternatives
Are there any alternatives to using tocilizumab in pregnancy?
Possibly. Other medicines can be used to treat rheumatoid arthritis during pregnancy, although these may not work as well as tocilizumab. If tocilizumab is working for you, staying on it during pregnancy may be your best option.
Tocilizumab is only used to treat severe COVID-19 in pregnancy when your doctor thinks it is the best option to help you recover and to prevent pregnancy complications.
If you are planning a pregnancy or have an unplanned pregnancy while being treated for rheumatoid arthritis, speak to your specialist about which medicine is best.
No treatment
What if I prefer not to take tocilizumab during pregnancy?
It is important that rheumatoid arthritis is well-treated during pregnancy to avoid a flare-up of your symptoms and reduce the chance of certain pregnancy complications. It is also important that severe COVID-19 is treated correctly as this can be very serious during pregnancy. Your doctor will be happy to discuss any concerns.
Will I or my baby need extra monitoring?
As part of routine antenatal care in the UK, women are invited for a very detailed scan at around 20 weeks of pregnancy to check the baby’s development. No further scans to check for birth defects will be required, although extra growth scans may be offered to women with rheumatoid arthritis or who have had severe COVID-19.
Are there any risks to my baby if the father has used tocilizumab?
There is currently no evidence that tocilizumab used by the father can harm your baby through effects on the sperm.
Who can I talk to if I have questions?
If you have any questions regarding the information in this leaflet, please discuss them with your health care provider. They can access more detailed medical and scientific information from www.uktis.org.