From the FDA Drug Label
Of these 51 patients, 26 (51%) were naive to subcutaneous ACTEMRA and 25 (49%) had been receiving ACTEMRA intravenously and switched to subcutaneous ACTEMRA at baseline Eligible patients received ACTEMRA subcutaneously dosed according to body weight, with patients weighing at or above 30 kg (n = 26) dosed with 162 mg of ACTEMRA every week and patients weighing below 30 kg (n = 25) dosed with 162 mg of ACTEMRA every 10 days (n=8) or every 2 weeks (n=17) for 52 weeks
The recommended dose for pediatric patients with systemic JIA who weigh less than 30 kg is 162 mg of ACTEMRA every 10 days or every 2 weeks. Since the patient's weight is 23.5 kg, which is less than 30 kg, the recommended dose would be 162 mg every 10 days or every 2 weeks 1.
From the Research
For a pediatric patient with systemic juvenile idiopathic arthritis (sJIA) weighing 23.5 kg, the recommended dose of tocilizumab is 12 mg/kg administered intravenously every two weeks, as this dosing regimen has been shown to be effective in achieving clinical improvement and reducing inflammation in patients with sJIA, as demonstrated in a study published in 2012 2. This would calculate to approximately 282 mg per dose for this patient. Tocilizumab should be diluted to 100 mL in normal saline and infused over one hour. Before initiating therapy, baseline laboratory tests including complete blood count, liver function tests, and lipid panel should be obtained. Regular monitoring of neutrophil count, platelets, liver enzymes, and lipid levels is necessary during treatment. The medication works by blocking interleukin-6 receptors, which helps reduce inflammation associated with sJIA. Common side effects include increased risk of infections, neutropenia, thrombocytopenia, and elevated liver enzymes. Patients should be screened for tuberculosis and other infections before starting treatment. Live vaccines should be avoided during tocilizumab therapy. Dose adjustments may be necessary based on laboratory abnormalities or clinical response. It's worth noting that more recent studies, such as the one published in 2021 3, have explored the use of subcutaneous dosing regimens of tocilizumab in children with sJIA, but the intravenous dosing regimen remains a widely accepted and effective treatment option. Additionally, a case report published in 2023 4 highlighted the potential benefits of sequential tocilizumab and tofacitinib treatment for sJIA, but this approach requires further study to determine its safety and efficacy. Overall, the recommended dose of 12 mg/kg every two weeks is based on the strongest and most recent evidence available, and it is essential to carefully monitor patients for potential side effects and adjust the treatment plan as needed to optimize outcomes.