Drug2nd line4 diseases
Tocilizumab
Anti-IL-6 receptor monoclonal antibody
- Response rate
- ~61% (ACR50)
- Onset
- Weeks
- Route
- IV 8 mg/kg every 2-4 weeks or SC 162 mg weekly
- Line
- 2nd
- IgM effect
- Moderate ferritin reduction
- Evidence level
- green
Used across diseases
| Disease | Response rate | Line | Evidence |
|---|---|---|---|
| Adult-Onset Still's Disease | ~61% (ACR50) | 2nd | green |
| Familial Mediterranean Fever | Under investigation | Investigational | amber |
| Schnitzler Syndrome | Initial response, loss of efficacy | Alternative | default |
| TNF Receptor-Associated Periodic Syndrome | Case reports of efficacy | Alternative | default |
Evidence summary
IL-6 receptor blockade is particularly effective for the chronic articular phenotype with joint-predominant disease. The Kaneko et al. RCT (2018) demonstrated significant improvement in systemic feature score (p=0.003) and glucocorticoid sparing (p=0.017), with ACR50 at week 4 of 61.5% vs 30.8% placebo. IL-6 blockade reduces CRP, ferritin, and hepatic acute-phase reactant production. May be preferred over IL-1 blockade when arthritis dominates the clinical picture.
Molecular targets
| Molecule | Role | Expression | Evidence |
|---|---|---|---|
| IL-6 | Pleiotropic cytokine driving acute-phase response and joint destruction | Elevated | established |
Sources (3)
DetailsKaneko Y et al. (2018) Tocilizumab in patients with adult-onset Still's disease refractory to glucocorticoid treatment: a randomised, double-blind, placebo-controlled phase III trialPubMed ↗