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Tocilizumab: From Bench to Bedside - A Comprehensive Review.

Alexandre Khoury1, Laura El Halabi1, Anthony Al Bayeh1

  • 1The University of Kansas School of Medicine-Wichita, Wichita, Kansas, Department of Internal Medicine.

Kansas Journal of Medicine
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Summary

Tocilizumab effectively treats autoimmune diseases and manages cytokine release syndrome (CRS) in cancer therapy. Global access to tocilizumab and its biosimilars is uneven, posing challenges in low- and middle-income countries.

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Area of Science:

  • Immunology
  • Pharmacology
  • Oncology

Background:

  • Interleukin-6 (IL-6) is a critical mediator in inflammation and cancer.
  • Tocilizumab, an IL-6 receptor blocker, is vital for treating autoimmune conditions and managing cytokine release syndrome (CRS) in CAR-T cell therapy and bispecific antibody treatments.
  • Global disparities exist in tocilizumab access and biosimilar adoption.

Purpose of the Study:

  • To review clinical applications and safety of tocilizumab.
  • To examine tocilizumab's role in oncologic and CRS-related conditions.
  • To assess global access, pricing, and biosimilar availability of tocilizumab.

Main Methods:

  • A PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses - Scoping Reviews) approach was employed.
  • Evidence from published studies, clinical data, and economic reports was mapped.
  • Included data covered approved and emerging indications, CRS management, and global market dynamics.

Main Results:

  • Tocilizumab demonstrates consistent anti-inflammatory efficacy and a known safety profile in autoimmune diseases and COVID-19.
  • It is the standard for moderate-to-severe CRS in CAR-T therapy and is increasingly used with bispecific antibodies.
  • Biosimilars have reduced costs in high-income regions, but affordability and access remain issues in lower-income countries.

Conclusions:

  • Tocilizumab is integral to autoimmune care, supportive oncology, and emerging cancer therapies.
  • Future efforts should focus on enhancing biosimilar accessibility and refining CRS management strategies.
  • Expanding high-quality oncologic trials for IL-6 blockade is a crucial next step.