Rheumatoid Arthritis (RA)
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What to Expect When You’re Starting an IL-6 Inhibitor to Treat Rheumatoid Arthritis

An interleukin 6 inhibitor is a biologic given by infusion or injection. Here’s what it’s like to take one — and when you can expect to find relief.

Maria Masters
By
Samir Dalvi, MD
by
Published on February 22, 2024

Your doctor has recommended expanding your treatment plan for rheumatoid arthritis (RA) to include an interleukin 6 (IL-6) inhibitor — a biologic that’s often prescribed when conventional disease-modifying antirheumatic drugs (DMARDs) haven’t worked well enough to relieve joint pain, stiffness, and other symptoms.

As hopeful as you may be that a new drug may help you feel better, you’re also likely to have a lot of questions. Will you need to prepare ahead of time? How will you take the drug? Are there potential side effects to know about and manage? With answers to questions like these, you'll be ready to try a new drug and get the best possible outcome from it.

Before You Start Taking an IL-6 Inhibitor for RA

Adding a new drug to your RA treatment plan will require some advance work. For example, your doctor will order tests to evaluate aspects of your health, and you may need to make some other changes to your treatment regimen.

To prepare to add an IL-6 inhibitor to your treatment plan, expect to:

What It’s Like to Take an IL-6 Inhibitor for RA

You have two choices when it comes to taking an IL-6 inhibitor. Depending on the specific medication your doctor prescribes, you may either self-administer it using a syringe or injection pen, or you'll get an infusion.

Self-Administered Injections

Tocilizumab and sarilumab are available as syringes or injection pens that come prefilled with the prescribed dose of medication. Injection pens can be especially appealing to people who are squeamish about needles, because they’re designed so that the needle is hidden. Both forms of medication need to be stored in the refrigerator.

Whether you use a syringe or injection pen, the steps for administering an IL-6 inhibitor are basically the same:

  1. Take the medication out of the fridge to bring it to room temperature, because it can be uncomfortable if it goes into your body ice cold. Syringes can be ready to use in about a half hour, but pens need around an hour to warm up.
  2. Meanwhile, gather your supplies: alcohol prep pads, cotton balls, a small adhesive bandage, and a sharps container to dispose of the used syringe or pen.
  3. When it’s time to take the medication, choose an area on your body. The ideal spots are the stomach (a few inches away from the belly button) and the front of the thigh. You’ll want to rotate where you give your injections so that you aren’t sticking the same spot every time.
  4. Wash and dry your hands thoroughly.
  5. With an alcohol pad, swab the spot where you’ll be injecting the drug.
  6. Take the shot.

If using a syringe?With your thumb and forefinger, pinch a bit of skin on your belly or thigh. Insert the needle in a single, swift motion, press the syringe to release the medication into your body, and gently remove the needle when done.

If using a pen?Position the tip of the pen against your skin where you want to inject the medication and press the button to release the needle into your skin. You’ll hear a click when the medication starts to flow and a second click when it’s finished and you can take the pen off your skin.

  1. Cover the injection site with a bandage if you’d like.
  2. Place the used syringe or pen into the sharps container.
  3. Plan for your next injection using whatever type of reminder works best for you, such as writing it on a paper calendar, setting a notice on your phone, or placing a sticky note on the fridge. If you’re prescribed tocilizumab, your doctor will have you take it either weekly or every other week. If you’re taking sarilumab, you’ll do your injections every two weeks.

Infusion

Only tocilizumab can be given as an infusion, rather than a self-injection. Although this option requires a trip to an infusion center, you’ll only have to go once a month, and the procedure itself is straightforward.

  1. You’ll arrive for your appointment with a little time to spare, so you can check in and, if necessary, fill out paperwork, provide your copay, and so forth.
  2. When it’s time for your infusion, someone will take you to the infusion area and help you settle into a chair.
  3. A nurse will locate a vein on the inside of your arm, swab the area with an antiseptic, insert a needle through your skin into the vein, and use medical tape to secure the needle.
  4. They’ll then attach the needle to a tube connected to a bag containing your medication.?
  5. You’ll need to stay in place until the bag is fully empty, at which point the nurse will remove the needle. They may put a small bandage over the area.
  6. Adverse reactions to IL-6 inhibitors aren’t common, but you’ll likely be asked to stay at the infusion center for a half hour or so, just in case you have an allergic reaction or other complication from the drug.

How to Prep for an IL-6 Inhibitor Infusion

You won’t have to do anything while receiving an IL-6 infusion, but you can make the experience as comfortable and easy as possible with some preparation.
  • Clear your schedule. Allow enough time to get to and from your appointment, as well as fill out paperwork and do other preparation at the infusion site. The actual procedure will take about an hour.
  • Wear comfortable clothing. Choose a short-sleeve top to make it easy to put the IV in place, but bring a sweater, hoodie, or blanket to wrap around you in case the infusion center is chilly. Since you’ll be sitting for a long time, you might want to wear comfy bottoms (sweats or yoga pants, for example).
  • Bring something to do. Reading material, your laptop, or a downloaded podcast or movie (plus headphones or earbuds) can help you pass the time. If the infusion center allows it, you may even be able to bring along a friend to keep you company.
  • Pack a snack. Bring a protein bar, apple slices, crackers, or something else easy to eat in case you get hungry.
  • Have a full bottle of water on hand. Once you’re hooked up to the IV, you won’t be able to get up to grab a drink if you get thirsty.

Treatment Timeline

IL-6 inhibitors and other biologics tend to work quicker than conventional DMARDs, says Dr. Terracina. In fact, you may start feeling better within a few weeks.

Are There Side Effects or Other Concerns?

Before being widely prescribed, all medications are rigorously tested in clinical trials. Even so, most drugs are associated with some degree of risk and uncertainty. If you’re apprehensive about taking a drug that’s new to you, tell your doctor. They can prepare you for potential side effects and help you understand the importance of regular monitoring to check for changes in your health that may have been brought on by the drug. They can also tell you how to handle any issues that may arise while taking an IL-6 inhibitor.

Common Side Effects of IL-6 Inhibitors

Potential Complications of IL-6 Inhibitors

If routine testing shows any of these changes in your blood work, your doctor may conclude that the IL-6 inhibitor you’re taking, or the dose, isn’t right for you.

  • A rise in your cholesterol levels?High cholesterol can increase the risk of heart disease.
  • A low neutrophil count Neutrophils are a type of white blood cell. If your neutrophil count drops too low, it’s a sign the medication is suppressing the bone marrow too much, making it harder for your body to fight infections, says Terracina. When that happens, “We ask patients to stop the medication,” she says. Another option may be to adjust the dose.
  • A low blood platelet count?If your blood platelets are too low, your blood won’t be able to clot effectively, which can increase the risk of bleeding.
  • High liver enzymes?This can indicate inflammation in the liver, which can cause liver damage.

Voices of Experience: Real-Life Tips for Taking an IL-6 Inhibitor

“Do not be afraid. Today’s injection devices are easy [to use] and barely even hurt.”

?— Rick Phillips, 66, Indianapolis; living with RA for 23 years
“Do not be afraid. Today’s injection devices are easy [to use] and barely even hurt.”

“Apply an ice cube to the injection site for at least a minute. If ice is too messy, get a numbing cream, and apply it directly to the site.”

?— Rick
“Apply an ice cube to the injection site for at least a minute. If ice is too messy, get a numbing cream, and apply it directly to the site.”

“Allow some downtime, if possible, the day after your injection.”

?— Laura G., Puget Sound, Washington
“Allow some downtime, if possible, the day after your injection.”

“Drink plenty of fluids the day before [infusions]. You will want your veins expanded, and water helps do that.”

?— Laura
“Drink plenty of fluids the day before [infusions]. You will want your veins expanded, and water helps do that.”

“Ask the nurse to rotate your arms [for each infusion]. My arm is less tender if I have the site moved each time.”

?— Rick
“Ask the nurse to rotate your arms [for each infusion]. My arm is less tender if I have the site moved each time.”

“Give the medication time to work. If you have minor side effects, check with your doctor. Sometimes the side effects go away on their own as your body gets used to the drug.”

?— Laura
“Give the medication time to work. If you have minor side effects, check with your doctor. Sometimes the side effects go away on their own as your body gets used to the drug.”
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Resources

  • High Cholesterol. Mayo Clinic. January 11, 2023.
  • Different Ways to Take Arthritis Medications. Arthritis Foundation. No date?
  • Biologics. Arthritis Foundation. September 2, 2022.
  • Yip RM et al. Role of Interleukin 6 Inhibitors in the Management of Rheumatoid Arthritis. Journal of Clinical Rheumatology. December 2021.
  • Favalli E et al. Understanding the Role of Interleukin-6 (IL-6) in the Joint and Beyond: A Comprehensive Review of IL-6 Inhibition for the Management of Rheumatoid Arthritis. Rheumatology and Therapy. July 30, 2020.
  • Actemra (tocilizumab) injection. U.S. Food and Drug Administration.
  • Kevzara (sarilumab) injection. U.S. Food and Drug Administration.
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