What is your approach to managing abnormal lipids in a patient on tocilizumab?

This discussion would apply to treating rheumatoid arthritis with tocilizumab: A baseline lipid panel is standard of care to be drawn prior to initiation of tocilizumab therapy. If the baseline lipid panel (before therapy) were abnormal, I would initiate a discussion about changes in diet and the possibility of worsening lipid panel ratios with the introduction of tocilizumab therapy; I would give the patient the option of starting another biologic or postponing therapy. Other risk factors such as family history, personal history of diabetes, BMI as well as hx of cardiovascular disease need to be reviewed and when comorbidities (especially diabetes and CV disease) are present, the situation warrants the primary care review (or endocrinologi...