tocilizumab; atlizumab (Actemra, RoActemra)

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Indications

* may be coadministered with methotrexate

Contraindications

Pregnancy category: C[2]

Dosage

4-8 mg/kg IV every 4 weeks

Monitor

Adverse effects

Mechanism of action

Management

More general terms

References

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    Yokota S et al, Efficacy and Safety of tocilizumab in patients with systemic- onset juvenile idiopathic arthritis: A randomized, double-blind, placebo-controlled, withdrawal phase III trial. Lancet 2008, 371:998 PMID: https://www.ncbi.nlm.nih.gov/pubmed/18358927
    Bongartz T, Tocilizumab for rheumatoid and juvenile idiopathic arthritis. Lancet 2008, 371:961 PMID: https://www.ncbi.nlm.nih.gov/pubmed/18358909
  2. 2.0 2.1 2.2 2.3 2.4 2.5 2.6 2.7 2.8 2.9 Medical Knowledge Self Assessment Program (MKSAP) 16, 17, 18, 19. American College of Physicians, Philadelphia 2012, 2015, 2018, 2022.
  3. Genovese MC, McKay JD, Nasonov EL et al Interleukin-6 receptor inhibition with tocilizumab reduces disease activity in rheumatoid arthritis with inadequate response to disease-modifying antirheumatic drugs: the tocilizumab in combination with traditional disease-modifying antirheumatic drug therapy study. Arthritis Rheum. 2008 Oct;58(10):2968-80 PMID: https://www.ncbi.nlm.nih.gov/pubmed/18821691
  4. Jones G, Sebba A, Gu J et al Comparison of tocilizumab monotherapy versus methotrexate monotherapy in patients with moderate to severe rheumatoid arthritis: the AMBITION study. Ann Rheum Dis. 2010 Jan;69(1):88-96 PMID: https://www.ncbi.nlm.nih.gov/pubmed/19297346
  5. 5.0 5.1 Singh JA, Beg S, Lopez-Olivo MA. Tocilizumab for rheumatoid arthritis. Cochrane Database Syst Rev. 2010 Jul 7;(7):CD008331 PMID: https://www.ncbi.nlm.nih.gov/pubmed/20614469
  6. 6.0 6.1 6.2 6.3 Loricera J et al. Tocilizumab in giant cell arteritis: Multicenter open-label study of 22 patients. Semin Arthritis Rheum 2015 Jun; 44:717 PMID: https://www.ncbi.nlm.nih.gov/pubmed/25697557
  7. Unizony S, Arias-Urdaneta L, Miloslavsky E et al Tocilizumab for the treatment of large-vessel vasculitis (giant cell arteritis, Takayasu arteritis) and polymyalgia rheumatica. Arthritis Care Res (Hoboken). 2012 Nov;64(11):1720-9 PMID: https://www.ncbi.nlm.nih.gov/pubmed/22674883
  8. 8.0 8.1 Villiger PM et al. Tocilizumab for induction and maintenance of remission in giant cell arteritis: A phase 2, randomised, double-blind, placebo-controlled trial. Lancet 2016 Mar 4 PMID: https://www.ncbi.nlm.nih.gov/pubmed/26952547
  9. 9.0 9.1 Bijlsma JWJ et al. Early rheumatoid arthritis treated with tocilizumab, methotrexate, or their combination (U-Act-Early): A multicentre, randomised, double-blind, double-dummy, strategy trial. Lancet 2016 Jun 7; PMID: https://www.ncbi.nlm.nih.gov/pubmed/27287832
    Scott DL. Beyond methotrexate monotherapy for early rheumatoid arthritis. Lancet 2016 Jun 7 PMID: https://www.ncbi.nlm.nih.gov/pubmed/27287831
  10. 10.0 10.1 Xie F, Yun H, Bernatsky S, Curtis JR. Brief report: Risk of gastrointestinal perforation among rheumatoid arthritis patients receiving tofacitinib, tocilizumab, or other biologic treatments. Arthritis Rheumatol 2016 Nov; 68:2612 PMID: https://www.ncbi.nlm.nih.gov/pubmed/27213279
  11. 11.0 11.1 FDA News Release. May 22, 2017 FDA approves first drug to specifically treat giant cell arteritis. https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm559791.htm
  12. 12.0 12.1 Stone JH, Tuckwell K, Dimonaco S et al Trial of Tocilizumab in Giant-Cell Arteritis. N Engl J Med 2017; 377:317-328. July 27, 2017 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/28745999 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMoa1613849
    Hellmann DB. Giant-cell arteritis - more ecstasy, less agony. N Engl J Med 2017 Jul 27; 377:385 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/28745998 <Internet> http://www.nejm.org/doi/10.1056/NEJMe1706439
  13. 13.0 13.1 Gever J FDA Approves CAR T-Cell Therapy for Leukemia. 'First gene therapy available in the United States,' says agency. MedPage Today. August 30, 2017 https://www.medpagetoday.com/HematologyOncology/Leukemia/67615
    FDA News Release. Aug 30, 2017 FDA approval brings first gene therapy to the United States. https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm574058.htm
  14. 14.0 14.1 14.2 Guaraldi P, Meschiari M, Cozzi-Lepri A et al Tocilizumab in patients with severe COVID-19: a retrospective cohort study. Lancet Rheumatology. 2020 Aug;2(8):e474-e484. PMID: https://www.ncbi.nlm.nih.gov/pubmed/32835257 PMCID: PMC7314456 Free PMC article https://www.thelancet.com/journals/lanrhe/article/PIIS2665-9913(20)30173-9/fulltext
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  16. 16.0 16.1 AMA News. Nov 9, 2020 American Medical Association
    Hermine O, Mariette X, Tharaux PL et al Effect of Tocilizumab vs Usual Care in Adults Hospitalized With COVID-19 and Moderate or Severe Pneumonia. A Randomized Clinical Trial. JAMA Intern Med. Published online October 20, 2020. PMID: https://www.ncbi.nlm.nih.gov/pubmed/33080017 PMCID: PMC7577198 https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2772187
    Gupta A, Wang W, Hayek SS et al Association Between Early Treatment With Tocilizumab and Mortality Among Critically Ill Patients With COVID-19. JAMA Intern Med. Published online October 20, 2020 PMID: https://www.ncbi.nlm.nih.gov/pubmed/33080002 https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2772185
    Stone JH, Frigault MJ, Serling-Boyd NJ et al Efficacy of Tocilizumab in Patients Hospitalized with Covid-19. N Engl J Med. 2020 Oct 21 PMID: https://www.ncbi.nlm.nih.gov/pubmed/33085857 https://www.nejm.org/doi/full/10.1056/NEJMoa2028836
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  18. 18.0 18.1 Veiga VC Effect of tocilizumab on clinical outcomes at 15 days in patients with severe or critical coronavirus disease 2019: randomised controlled trial. BMJ 2021;372:n84 PMID: https://www.ncbi.nlm.nih.gov/pubmed/33472855 PMCID: PMC7815251 Free PMC article https://www.bmj.com/content/372/bmj.n84
  19. 19.0 19.1 COVID-19 Treatment Guidelines. Last Updated: February 3, 2021 The COVID-19 Treatment Guidelines Panel's Statement on the Use of Tocilizumab (and Other Interleukin-6 Inhibitors) for the Treatment of COVID-19. https://www.covid19treatmentguidelines.nih.gov/statement-on-tocilizumab/
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