IL-6 inhibitors can raise cholesterol, so it’s important to establish your baseline levels. That way, your doctor can monitor your cholesterol while you’re on the drug — to catch any changes — or work with you to lower your cholesterol before you start.
Have your liver health evaluated.
Have your cholesterol tested.
IL-6 inhibitors can increase liver enzymes. If you have signs of liver inflammation, you may not be able to take an IL-6 inhibitor until the inflammation is under control.
If you’re carrying the virus, taking an IL-6 inhibitor could reactivate it. This doesn’t mean you won’t be able to take the medication, but your doctor may prescribe an antiviral to suppress the virus, according to Nancyanne Schmidt, MD, an assistant professor of medicine at Columbia University College of Physicians and Surgeons.
Be tested for hepatitis B.
As with hepatitis B, taking an IL-6 inhibitor can “wake up” latent (inactive) TB bacteria. If you test positive, you may need to take an antibiotic before starting an IL-6 inhibitor.
Take a tuberculosis (TB) test.
If you’ve been taking another biologic, such as a tumor necrosis factor (TNF) inhibitor, you’ll need to go off it before you begin taking an IL-6 inhibitor. Otherwise, you could suppress your immune system too much, explains Katherine Terracina, MD, a rheumatologist at UTHealth Houston. But, she notes, you likely won’t need to stop taking a conventional DMARD.
Stop taking other biologics.
Most private insurance companies, as well as Medicare, will cover the drug, but they may have requirements, such as trying more than one other RA medication first. Some drug companies may even help pay for the medication if you’re uninsured.
Make sure your insurance provider will cover an IL-6 inhibitor.