Tocilizumab
Mechanism :
Tocilizumab is an antagonist of the interleukin-6 (IL-6) receptor.
Indication :
- Cytokine release syndrome
- Polyarticular juvenile idiopathic arthritis
- Systemic juvenile idiopathic arthritis:
Contraindications :
Known hypersensitivity to tocilizumab or any component of the formulation.
Dosing :
Systemic Juvenile Idiopathic Arthritis, Cytokine release syndrome:
IV: (Infuse over 1 hour)
≥2 years, <30 kg: 12 mg/kg IV every 2 weeks.
≥2 years, ≥30 kg: 8 mg/kg IV every 2 weeks.
Systemic Juvenile Idiopathic Arthritis, SC injection:
≥2 years, <30 kg:
162 mg SC once every 2 weeks.
≥2 years, ≥30 kg:
162 mg SC once weekly.
Polyarticular Juvenile Idiopathic Arthritis:
IV infusion: IV (Infuse over 1 hour)
≥2 years, <30 kg: 10 mg/kg IV every 4 weeks.
≥2 years, ≥30 kg: 8 mg/kg IV every 4 weeks.
SC injection:
≥2 years, <30 kg:
162 mg SC once every 3 weeks.
≥2 years, ≥30 kg:
162 mg SC once every 2 weeks.
Adverse Effect :
Increased serum cholesterol, increased serum alanine and aspartate aminotransferase, injection site reaction, hypertension, peripheral edema, headache, dizziness. Serious and potentially fatal infections (including active tuberculosis, invasive fungal, bacterial, viral, protozoal, and other opportunistic infections).
Interaction :
Abatacept: Tocilizumab may enhance the adverse/toxic effect of Abatacept.
Anti-TNF Agents: Tocilizumab may enhance the immunosuppressive effect of Anti-TNF Agents.
Vaccines (Live): Avoid use of live organism vaccines with immunosuppressants; live-attenuated vaccines should not be given for at least 3 months after immunosuppressants.
Hepatic Dose :
Dose adjustment guidelines are not available, as dosing has not been studied. In patients with hepatic impairment or active hepatic disease, the use of this drug is not recommended. Monitor liver function. Do not use this drug if ALT or AST levels are more than 1.5 times the upper limit of normal (ULN).
If during treatment:
ALT/AST are persistently greater than 1 to 3 times the ULN: reduce the dose of therapy or stop treatment until levels normalise.
ALT/AST are persistently greater than 3 to 5 times the ULN: stop therapy till it is less than 3 times the ULN and then start again at a reduced dose.