The Scottish Medicines Consortium (SMC) has accepted tocilizumab (RoActemra®) for use within NHS Scotland for the treatment of moderate to severe active rheumatoid arthritis (RA) in adults who have either responded inadequately to, or who were intolerant to, previous therapy with one or more disease-modifying anti-rheumatic drugs (DMARDs) or tumour necrosis factor (TNF) antagonists. 

Tocilizumab can be given in combination with methotrexate, or as monotherapy in case of intolerance to methotrexate or where continued treatment with methotrexate is inappropriate.  According to the drug advice, the SMC has restricted tocilizumab for use within NHS Scotland in combination therapy, as the manufacturer did not present an economic case for monotherapy. 

Toculizumab should be used in accordance with the British Society of Rheumatology guidelines for prescribing TNF-α blockers in adults.