Abstract
Tocilizumab (Actemra; Genentech, Inc) is the first biologic therapy targeting the cytokine interleukin 6 (IL-6). It is a humanized monoclonal immunoglobulin G1 antibody against the α-chain of the IL-6 receptor that prevents the binding of IL-6 to membrane-bound and -soluble IL-6 receptor. It was approved by the US Food and Drug Administration in January 2010 for rheumatoid arthritis refractory to other approved therapies and in April 2011 for systemic juvenile idiopathic arthritis. It has been used as an off-label treatment in many autoimmune diseases, where IL-6 plays a major role in pathogenesis. We report a case of refractory systemic lupus erythematosus in a 22-year-old woman with recurrent high-grade fever, polyarthritis, diffuse rash with urticarial vasculitis, and tumid lupus who did not respond to topical corticosteroids, photoprotection, antimalarials, methotrexate, anakinra, mycophenolate mofetil, etanercept, and intravenous immunoglobulin therapy. Symptoms recurred after corticosteroid tapers below 10 mg. She was noted to have an elevated IL-6 level, and tocilizumab was started. She responded favorably with remission of fever, arthritis, and skin manifestations and was able to taper corticosteroid therapy successfully.
References
Mar 1, 1991·Arthritis and Rheumatism·D J KlashmanR H Stevens
Mar 1, 1991·International Immunology·B TangT Kishimoto
Aug 1, 1994·The Journal of Clinical Investigation·B K FinckD Wofsy
May 1, 1993·European Journal of Immunology·H SuzukiT Kishimoto
Dec 1, 1996·Lupus·E PetersonW Emlen
Jul 2, 1998·Clinical and Experimental Immunology·M MiharaY Ohsugi
Jun 27, 2000·Nephron·C Y TsaiY Y Tsai
Jun 4, 2002·Best Practice & Research. Clinical Rheumatology·Jeffrey P Callen
Aug 11, 2006·Arthritis Research & Therapy·Peter E Lipsky
Oct 28, 2006·Immunology·Bailin LiangXiao Yu R Song
Jun 26, 2007·Journal of Clinical Immunology·Hye-Young ChunChang-Hee Suh
Jan 10, 2008·Dermatology : International Journal for Clinical and Investigative Dermatology·Imad UthmanSamer Ghosn
Feb 5, 2009·Autoimmunity Reviews·J E FonsecaE Choy
Aug 8, 2009·The Australasian Journal of Dermatology·Violet KieuChristopher McCormack
Jan 30, 2010·Arthritis and Rheumatism·Gabor G IlleiPeter E Lipsky
Citations
Nov 9, 2012·International Journal of Biological Sciences·Toshio Tanaka, Tadamitsu Kishimoto
Mar 22, 2014·Clinical Reviews in Allergy & Immunology·Cheng ZhangXing-Hua Chen
May 30, 2015·Cutaneous and Ocular Toxicology·Özgül Muştu Koryürek, Göknur Kalkan
Feb 6, 2013·Journal of Autoimmunity·Cong YuJianzhong Zhang
Feb 12, 2013·Annales de dermatologie et de vénéréologie·M SamimiL Machet
Oct 31, 2012·Cytokine & Growth Factor Reviews·Parvin Ataie-KachoieDavid L Morris
Oct 2, 2015·Seminars in Immunopathology·C Schlapbach, A A Navarini
Jan 23, 2016·Expert Review of Clinical Pharmacology·Anna Sophie Klaeschen, Joerg Wenzel
Mar 5, 2013·Nephrology·Desmond Yat Hin Yap, Kar Neng Lai
Jul 15, 2015·Autoimmunity Reviews·Manfred RelleAndreas Schwarting
Jul 19, 2014·Rheumatic Diseases Clinics of North America·Mark G Kirchhof, Jan P Dutz
Mar 15, 2015·Cytokine·E S Robinson, V P Werth
May 29, 2013·The Journal of Allergy and Clinical Immunology·Karoline KrauseMarcus Maurer
Mar 26, 2015·Immunotherapy·Natasha JordanDavid P D'Cruz
Apr 10, 2014·PloS One·Xin LuGuochun Wang
Jun 2, 2016·Expert Review of Clinical Immunology·Joshua Chang, Victoria P Werth
Jun 3, 2016·Lupus·A KuhnJ Wenzel
Jun 24, 2017·Tumour Biology : the Journal of the International Society for Oncodevelopmental Biology and Medicine·Qian LiuKongming Wu
Dec 2, 2015·Therapeutic Advances in Musculoskeletal Disease·Natasha Jordan, David D'Cruz
Aug 18, 2018·Expert Opinion on Biological Therapy·Oshrat E Tayer-ShifmanZahi Touma
Mar 21, 2020·Lupus·Gehan ElolemyFatema Alkhawaja
Jun 9, 2016·Current Opinion in Rheumatology·Jasmine N Stannard, J Michelle Kahlenberg
Aug 13, 2015·Journal of Clinical Rheumatology : Practical Reports on Rheumatic & Musculoskeletal Diseases·Michaela CellinaGiancarlo Oliva
Jan 8, 2016·Experimental Dermatology·Peter BirnerLukas Kenner
Jul 13, 2020·Scandinavian Journal of Immunology·Xinyu ZhouLan Fan
Dec 15, 2018·Pediatric Rheumatology Online Journal·Ju-Yang JungHyoun-Ah Kim
Jul 25, 2017·Clinical Rheumatology·Ryota SakaiKoichi Amano
May 19, 2021·Dermatologic Therapy·Dean Jeremy Choong, Ernest Tan