Tocilizumab

Question 1

What class of drugs does Tocilizumab belong to?

Answer 1

Immunomodifers

cytokine modulators

Question 2

What is Tocilizumab?

Answer 2

A recombinant, humanised, anti-human IL-6 receptor monoclonal antibody .

Question 3

What are examples of other drugs in the same class as Tocilizumab?

Answer 3

Anakinra,
Adalimumab,
Etanercept
infliximab

Question 4

What is Tocilizumab indicated for?

Answer 4

Moderate to severe active rheumatoid arthritis when response to at least one DMARD or TNF inhibitor has been inadequate or are intolerant.

Question 5

What is the dose of Tocilizumab given to rheumatoid arthritis patients?

Answer 5

Adult: 8mg/kg once every 4 weeks via IV infusion.

max 800mg per infusion

Question 6

What is the mechanism of action of Tocilizumab?

Answer 6

Tocilizumab binds specifically to soluble and membrane bound IL-6 receptors, thus inhibiting the cytokine’s

paracine function, and induction of immunoglobulin secretion,
T cell activation,
Induction of hepatic acute phase proteins
and stimulation of haematopoiesis.

Question 7

What is the role of Tocilizumab in Rheumatoid Arthritis therapy?

Answer 7

It is used in combination with MTX except for patients intolerant to MTX in which case it can be used alone.

Question 8

What are the characteristic pharmacokinetic and pharmacodynamic parameters of Tocilizumab?

Answer 8

Volume of distribution(ss): 4.08L
Clearance: concentration dependent
Half life: 13 days

Question 9

What are the precautions associated with Tocilizumab use?

Answer 9

predisposition to infection
history of recurrent/chronic infection
history of intestinal ulceration or diverticulitis
demyelinating disorder
CVD risk factors
hepatic impairment,
renal impairment,
avoid in pregnancy 
Use only in breastfeeding if benefit outweighs risk

Question 10

What are the contraindications of Tocilizumab?

Answer 10

severe active infection
absolute neutrophil count < 2x10^9/L
hypersenstivity to recombinant human or humanised antibodies, CHO cell products,

Question 11

What are the adverse reactions associated with tocilizumab use?

Answer 11

Increased risk of malignancy
Invasive fungal infection
Infusion reactions: raised lipids, blood dyscrasia, elevated LFT, mouth ulcers, GI upset, URTI, cough, bronchitis, nasopharyngitis, back pain, oedema, rash, headache, dizziness, hypertension, neutralising AB formation

Question 12

What are the drug interactions associated with tocilizumab use?

Answer 12

avoid concomitant use with live vaccines

Question 13

What are the alarm bells associated with tocilizumab?

Answer 13

monitor hepatic transaminases every 4-8weeks for the first 6 months of treatment, then every 12 weeks.

monitor neutrophil and platelet counts, lipid profile, 4-8 weeks after starting treatment and then as indicated.

monitor for demyelinating disorders

Evaluate for TB before starting treatment. Latent TB must be treated.
Patient to seek medical advice if abdominal pain, haemorrhage, or fever accompanying change in bowel habits occur