tocilizumab

Tocilizumab is a humanized monoclonal antibody that blocks interleukin-6 (IL-6) signaling by binding to the IL-6 receptor (IL-6R), inhibiting inflammatory pathways. By reducing IL-6 activity, it helps control immune-mediated inflammation in several conditions. It is marketed under the brand name Actemra and is produced through Roche/Chugai collaboration. The medicine is available as an intravenous infusion and as a subcutaneous injection.

Therapeutic uses include rheumatoid arthritis in adults and children, where it may be used in combination with or after failure of other disease-modifying antirheumatic drugs. It is also approved for polyarticular juvenile idiopathic arthritis and systemic juvenile idiopathic arthritis. Additional approved indications include giant cell arteritis and cytokine release syndrome (CRS) associated with CAR-T cell therapy. Off-label use for other inflammatory diseases has been reported but varies by region and clinical guidelines.

Administration and dosing vary by indication and formulation. Intravenous tocilizumab is given as an infusion every few weeks, with schedules determined by disease, comorbidities, and concurrent therapies. Subcutaneous tocilizumab is administered as injections at a defined interval, typically weekly or every other week, depending on the approved regimen and patient factors.

Safety and monitoring considerations include an increased risk of serious infections, liver enzyme elevations, lipid abnormalities, and cytopenias (neutropenia and thrombocytopenia). Gastrointestinal perforation risk exists, particularly in patients with diverticular disease. Baseline screening for latent tuberculosis, regular monitoring of liver function tests, lipid panels, and blood counts, and vigilance for signs of infection are recommended during treatment. As with other immunomodulators, vaccination status should be reviewed prior to initiation.