20 December 2021
IV Tocilizumab Supply Update
The ARA have met today with representatives from the TGA, Arthritis Australia and Roche. Stock of IV tocilizumab arrived in Australia yesterday. While this is enough to ease the current severe shortage it is not enough to completely resolve the situation. We would like to thank rheumatologists who have worked with their patients to reduce the use of IV tocilizumab by 75% during this severe shortage which has allowed continuing supply to those most in need. This is a great achievement and has not been replicated in other countries.
Modelling by the TGA has demonstrated that given the recent increase in supply of IV tocilizumab there can be some changes to the recommendations for use for those patients who are currently or previously on IV tocilizumab.
Systemic juvenile idiopathic arthritis (sJIA) patients and polyarticular juvenile idiopathic arthritis (pJIA) patients
- Patients undergoing IV tocilizumab treatment for sJIA and pJIA may resume their normal dosing regimen.
- Patients with sJIA and pJIA can be initiated on IV tocilizumab if required.
Adult rheumatoid arthritis patients
- Adult patients who have been continued on IV tocilizumab treatment for rheumatoid arthritis during the shortage may resume their normal dosing regimen if dosing intervals have been increased during the shortage.
- For those adult patients who were previously on IV tocilizumab and were switched to alternative biologic or targeted synthetic agent due to the tocilizumab shortage, but are now experiencing flare requiring prednisolone, these patients may resume IV tocilizumab.
- We continue to recommend against initiation of adult RA patients onto IV tocilizumab.
During the shortage the amount of IV tocilizumab supplied to hospitals was significantly reduced, we have been reassured by Roche that these amounts will increase following this latest shipment. To be clear the amounts available to hospitals will still be reduced compared to pre-pandemic levels.
SC Tocilizumab Supply Update
Supplies of both of the SC tocilizumab preparations have improved but still remain lower than pre-pandemic levels. The Serious Scarcity Substitution Instrument (SSSI) has been extended until 30 April 2022 to allow substitution of the SC preparations at the dispensing level.
Initiation and ongoing use should be reserved for conditions with no alternatives (GCA and JIA). We continue to recommend against initiation of adult RA patients onto SC tocilizumab unless alternate therapy is not appropriate.
Due to the uncertainty of the ongoing COVID situation it is imperative that we continue to proceed with caution in usage of tocilizumab.
Please find below links to resources that may be useful during this shortage.
Useful links for Patients
- More information for patients including frequently asked questions can be found on Arthritis Australia's website here.
Useful links for Pharmacists
- Information for pharmacies can be found on the TGA website here and as a downloadable pdf here
- Please note that pharmacists will need to call wholesalers to order tocilizumab. Wholesaler portals will likely show zero stock quantity for both subcutaneous medicines, even if they are available.
Additional useful links
- TGA, ARA and Arthritis Australia Joint Statement on the tocilizumab shortage
- This statement provides recommendations on the management of patients on tocilizumab during the shortage
- Further information can be found on the TGA website here
- PBS Arrangements for tocilizumab shortage can be found here
- More information for ARA Members including a webinar can be found here
- Roche Medical Information can be contacted on 1800 233 950