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Rheumatoid Arthritis — SCE Rheumatology MCQ

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HardRheumatoid ArthritisRheumatoid ArthritisSCE Rheumatology

A patient with rheumatoid arthritis receiving tocilizumab has a confirmed ALT concentration greater than five times the upper limit of normal. Viral hepatitis testing is negative. What is the appropriate drug action?

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Correct answer: B — Discontinue tocilizumab now and investigate alternative causes of liver injury

A confirmed ALT elevation above five times the upper limit of normal meets the stopping threshold for tocilizumab. The drug should be discontinued and other causes of liver injury assessed rather than relying on dose reduction or route substitution.

Reference: UK RoActemra summary of product characteristics (Current UK SmPC, accessed 30 July 2026): https://www.medicines.org.uk/emc/product/6673/smpc; BNF: tocilizumab (Current BNF monograph, accessed 30 July 2026): https://bnf.nice.org.uk/drugs/tocilizumab/