LOW WHITE BLOOD COUNT FROM KEVZARA

Hi! Yes. Kevzara tanked some of my blood markers, especially my white blood cell count. I was taken off Kevzara and put on Humira. BTW neither medication worked to ease my horrible on-going pain and bone destruction. (All from a Shingrix shot).

I was supposed to have my left shoulder replaced (reverse) last April but my surgeon had me wait many months until my count rose. Had my reverse total shoulder replacement done 10/29/25. I am finishing up with physical therapy this week. Will need to have my right shoulder replaced.

I have read in these posts, someone switched to taking Kevzara every 3 weeks and it helped to keep the blood work in check. Good luck!!

It was me who said …
“ I have read in these posts, someone switched to taking Kevzara every 3 weeks and it helped to keep the blood work in check.”
4 months later and it’s even better.
Note: I am just coming up on 1 yr, and no side effects, or other health issues. Hoping to be taken off it next week.

My rheumatologist changed my Kevzara to every 3 weeks when my platelets dropped to under 100,000 and now better 8 weeks later. My WBCs have been okay.

I'm curious to know what your actual WBC counts were. My WBCs were slightly below normal when I was first started on an IL-6 receptor blocker (Actemra). I think it happens but research suggests it isn't associated with an increased risk of infections. People on Kevzara and Actemra are still immunosuppressed. In my personal experience ... I have fewer infections on Actemra alone compared to when I was on prednisone on alone.

I had to be extra careful when I was on both Prednisone and Actemra. As I recall ... my blood WBC was low only when I was on both Actemra and Prednisone.

Two days after my first Kevzara injection my rheumatologist got all weird about my low white count. I coerced her to look at the Kevzara guidelines with me there, and I was above the “do not continue” level. She said, “oh okay, you can take your second injection but let’s keep an eye on today’s bloodwork.” It was better, still low, but safe.
I discussed it with my PCP and he said not to worry, that it was expected.

I’m definitely following this thread. Thanks for your input.

@tweetypie13
Hope that you can stop taking Kevzara. Not quite sure of the drug's purpose. Don't think that it really helped with the pains of PMR. Prednisone took care of that. Was supposed to prevent flare ups, I guess. Both my wbc and globulin levels decreased. To me, these markers should be checked every three months along with inflammation and liver functions. Hope that you will be feeling good!

@dadcue
my wbc count was 2.8.
my globulin count was 1.5
I have been off prednisone since last July of 2025.
Wanted to stop Kevzara, too - but he said "no".
I can understand not stopping two drugs at the same time.
Why stay on Kevzara if your blood inflammation levels are low? Don't have the names of those markers here.
I want to get this poison out of my system.

@sandranovicki74
"Why stay on Kevzara if your blood inflammation levels are low? Don't have the names of those markers here. I want to get this poison out of my system."
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I trusted my rheumatologist who started Actemra to make the right decisions regarding my lab values. Before I retired, I was in a position where I needed to be "aware" of a patient's lab values but most of the time I was not qualified to make changes in their medications. The lab would report "critical lab values" to me and I was responsible to report the values to the patient's doctor.
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ESR (Erythrocyte Sedimentation Rate) and CRP (C-reactive protein) are non-specific blood tests used to detect and monitor inflammation. If they are very low it is an indication that Kevzara is working. If they aren't low that might indicate that Kevzara is not working.

If you stopped Kevzara your ESR and CRP would probably gradually increase again. It could mean you would have to take Prednisone again. The usual time to take Kevzara is one year before stopping it gradually. Research shows that stopping Kevzara suddenly and too soon increases the risk of a relapse.

I remember when I started Actemra. I never saw my ESR and CRP stay so low. I asked my doctor if my ESR and CRP were too low. When I was taking Prednisone, my ESR and CRP were all over the place but mostly too high.
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A WBC level of 2.8 is on the low side. That sometimes happens when you are taking an IL-6 inhibitor. This is where "trends" are more important than a single lab value.

Are your WBCs low and getting lower?
Are your WBCs low and improving?
Are your WBCs low and staying the same?
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The more helpful lab value is the Absolute Neutrophil Count (ANC). It is a lab value measuring the actual number of infection-fighting neutrophils in the blood. My WBC was low but my ANC was still in the normal range so my doctor told me to continue Actemra. I have now been on Actemra for 7 years and all my blood counts are normal.
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I had the advantage of seeing an endocrinologist when I tapered off prednisone. The endocrinologist was monitoring my hormone levels which were described as "dangerously low" in some cases and "way too high" in other cases. It was amazing how many of my hormones were out of balance from long term Prednisone use. It made me wonder why my rheumatologist never checked hormone levels when I took Prednisone.

I can live with some lab abnormalities from Actemra. That was my decision and it was my rheumatologist's recommendation that I continue Actemra.

I have been on Actemra for 7 years and I have no regrets.

I have many regrets about taking Prednisone for 12 years. My rheumatologist agrees and says my overall condition is much better since I started Actemra

@dadcue
Thx for clarifying these numbers….
I was much better with understanding after it was clarified for me.
EVERYONE READ THIS AND THANK MIKE.

@tweetypie13
"It is believed—and supported by clinical data—that IL-6 inhibitors (such as tocilizumab) reduce the absolute neutrophil count (ANC) in the bloodstream by promoting the redistribution (or margination) of neutrophils out of circulation and into non-circulating pools, such as the bone marrow and spleen"

I don't really know but the following makes some sense to me.
https://pmc.ncbi.nlm.nih.gov/articles/PMC7376291/.
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The Absolute Neutrophil Count (ANC) is a subset of the total White Blood Cell (WBC) count. A lower circulating ANC almost always corresponds to a lower total WBC count. I was told as long as my ANC wasn't below normal I could safely stay on Actemra. There are other kinds of WBCs that have other functions.
https://my.clevelandclinic.org/health/body/21871-white-blood-cells
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The ANC decrease is because the IL-6 signal is turned off when we are on an IL-6 inhibitor. The cells aren't destroyed ---they go back into storage and aren't circulating in the blood. They supposedly come out of storage if we get an infection but we are still immunosupressed.