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Infections and starting Actemra
Hello all.
I was wondering what thoughts any of you have about starting Actemra when you possibly have a fungal Infection.
The reason I say possibly is because, and I have no idea why, I tend to get fungal rashes which can appear on my torso and under my arms about 3 or 4 times a year for which I'm usually prescribed anti fungal meds. Probably because I'm run down and vulnerable to low level, persistent or systemic infections over the past few years. I have a recurrent problem with a rash at the top of my inner thighs that never really goes away. My dermatologist gave me some anti-fungal cream and anti-fungal meds when it flared not long ago and, if she saw the rash today, she'd probably do the same thing again. So, it seems that I'm susceptible to fungal Infections of some sort or my body overreacts to them in some way.
My rhumatologist is keen to get me started on Actemra injections so that I can start to feel better but, as you'll know, taking it if you have a virus, take antibiotics, have dental work planned or have obvious infections means you have to pause the treatment at least. But, with low level, ongoing infections or recurring infections, what should be done?
Perhaps someone has prior experience with this issue.
Thank in advance for any comments.
Frank
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I know that the "recommendation" is to stop Actemra for ANY infection. In an ideal world you should also stop prednisone except prednisone should never be stopped abruptly.
I have had various infections that weren't "serious" enough to stop Actemra. I don't know if your infection qualifies as being serious or not. Several times I had infections that were deemed to be "not serious" and Actemra was never stopped. The infections either improved without any intervention or I received a "short course" of antibiotics. I think Actemra would have been stopped if I had needed the antibiotics longer.
During my 6 years on Actemra, there was a need to stop it twice. Once was a supply chain issue during Covid and Actemra was unavailable. I didn't have Covid but I know some people with Covid received Actemra while in the hospital. All the sick people in the hospital with Covid had priority to get existing supplies of Actemra.
The first time, Actemra was stopped was when I had a flare of another autoimmune condition. I was on zero Prednisone so 60 mg was restarted The dilemma was whether or not a different biologic should be started. An ophthalmologist wanted to start me on Humira instead of Actemra. While it was being decided what to do my rheumatologist said Actemra wouldn't add any benefit to 60 mg of Prednisone. Humira was tried while Actemra was stopped because nobody should be on two biologics. When PMR flared up again, Humira it was stopped and Actemra was restarted.
The fungal skin infection is not a major concern. It can be cultured for
exact identification which can suggest the best topicals for management.
Most important is screening for TB and hepatitis before starting.
I asked my PCP for a chest X-ray to screen for lung infections as I am
working outside with soil frequently. Prednisone can also interfere with
our immunity against fungus. Have you discussed Actemra and your concerns
with both doctors?
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2 ReactionsDiverticulitis too. Any diverticulitis or history of diverticulitis probably should exclude people from receiving Actemra. Better to be safe than sorry.
https://pmc.ncbi.nlm.nih.gov/articles/PMC5127961/
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My rheumatologist screened me for everything and then only started me on an injection every two weeks to "play it safe." After six years, Actemra seems to be safe for me and now I do monthly infusions of Actemra.
Nothing unusual has ever happened to me. I have discontinued prednisone. If anything, all my prednisone side effects have gradually improved. I have also stopped several other medications that I took to treat prednisone side effects.
I would guess that I have fewer infections on Actemra than I did on prednisone. At least I don't have flares anymore when I have an infection. Even my fungal toenails are improving.
Before I started taking prednisone and Actemra, I did volunteer work to remove invasive plants like kudzu from greenways in my area. After reading the warnings about possible fungal infections if you're taking those drugs, I stopped doing that work. The greenways are in flood plains, and flood frequently. There are some nasty things in flood water. It doesn't seem like it's worth the risk to work in that environment.
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1 Reaction"Actemra (tocilizumab) can increase the risk of infections, including fungal infections, and individuals taking Actemra who live or have lived in the Ohio and Mississippi River valleys, or have traveled to these areas, may be at a higher risk of certain fungal infections."
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I live near the Mississippi but not on the river. I drive across the Mississippi fairly often. There is no way to go around it!
You must live in the South.
https://www.nature.org/en-us/about-us/where-we-work/united-states/indiana/stories-in-indiana/kudzu-invasive-species/
They say kudzu is making its way to the Midwest where I am. I'm hoping it won't cross the Mississippi.
I live in the Raleigh area of North Carolina. Kudzu can be very difficult to get rid of. We dug up some roots that were around 8 inches in diameter.