Rheumatoid Arthritis Pocket Guide: Full illustrated 2016 by HC-HealthComm

Author:HC-HealthComm [HC-HealthComm]
Language: eng
Format: epub
Publisher: HC-HealthComm
Published: 2016-02-27T16:00:00+00:00

Tocilizumab (Actemra®; manufactured by Chugai, IL, USA/Hoffman-LaRoche, CA, USA), is a anti-IL-6 receptor humanised monoclonal antibody. IL-6 is a pleiotropic cytokine involved in B- and T-cell activation, induction of acute phase reactants, and stimulation of hematopoietic precursor cell differentiation, and is overexpressed in synovial fluid, and may contribute to joint destruction via its effect on osteoclast function. It represents a new treatment option in patients with moderate to severe active RA who have either responded inadequately or are intolerant to previous treatment with one or more DMARDs or TNF antagonists.

In clinical studies tocilizumab was well tolerated and efficacious in alleviating the signs and symptoms of RA, as well as inhibiting radiological progression.92,93,94,95 The results of these studies led to the approval of tocilizumab by the European Medicines Agency (EMA) in January 2009 and by the FDA in January 2010. It is the ninth and newest biologic for RA. Recent long-term follow-up data from these clinical trials reported increasing clinical efficacy over time during 3.5 years of follow up.96

The unique features of tocilizumab include rapid onset of action (by 2 weeks) and higher rates of disease activity score (DAS) remission, which may in part be due to direct effects of IL-6 on acute phase reactants such as C-reactive protein. Its main disadvantages include frequent liver function test (LFT) abnormalities, transient neutropenia (although not temporally related to infections), and increased cholesterol levels (requiring statin use in 5%). A recent study showed that tocilizumab is highly effective in a setting close to real-life medical care with a rapid and sustained improvement in signs and symptoms of RA, and a manageable safety profile was seen over the 24-week study period.97 A metanalysis of pooled safety data of 4009 patients treated with tocilizumab over a mean duration of 2.4 years reported a stable safety profile over time without any new safety signals.98

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