[Tocilizumab. What comes after TNF-blockers in clinical routine?]

Tocilizumab, a monoclonal humanized antibody against IL-6, was licensed in January 2009 in combination with Methotrexate for the treatment of adult patients with moderately to severely active rheumatoid arthritis and inadequate response to one or more DMARDs or TNF antagonists. Tocilizumab is given once every 4 weeks as a 60-min single intravenous infusion at a dosage of 8 mg/kg body weight and may be used as a monotherapy in the case of MTX or DMARD incompatibility. Clinical response is rapid and lasting according to clinical measurements such as ACR response rates or DAS28, irrespective of previous therapy. Within 2 weeks of the first infusion, inflammatory parameters such as CRP and ESR decline and the haemoglobin concentration increases. Adverse events often include mild respiratory infections, transient elevation in liver enzymes, decrease in neutrophile counts and increase in serum lipids. In 8% of patients a lipid lowering therapy needs to be initiated. Diverticulitis with perforation has been observed. Serious infections occur in the range known with other biological therapies. The radiological data show a reduced rate of joint destruction after 1 year of therapy. Long-term follow-up shows good clinical efficacy with an increasing percentage of patients with good clinical response and good safety profile.