Masked early symptoms of pneumonia in patients with rheumatoid arthritis during tocilizumab treatment: a report of two cases

Fujiwara, Hiroshi; Nishimoto, Norihiro; Hamano, Yoshimasa; Asanuma, Nobuyuki; Miki, Shunji; Kasayama, Soji; Suemura, Masaki

doi:10.1007/s10165-008-0111-7

Cited by 26 publications

(14 citation statements)

References 16 publications

(20 reference statements)

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“…Upper respiratory tract infection was the most common, and serious infection also occurred more often in the TCZ group. TCZ can mask signs of infection, such as fever and general malaise [26]. Thus, infection should be always monitored in patients treated with TCZ.…”

Section: Discussionmentioning

confidence: 99%

Efficacy and safety of tocilizumab in Korean patients with active rheumatoid arthritis

Baek

Lim

Park

et al. 2019

Korean J Intern Med

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Section: Discussionmentioning

confidence: 99%

Efficacy and safety of tocilizumab in Korean patients with active rheumatoid arthritis

Baek

Lim

Park

et al. 2019

Korean J Intern Med

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“…However, daily clinical practice including post-marketing surveillance (PMS) in Japan suggests that the incidence of AEs during TCZ therapy appears to have increased compared to other biologics in clinical practice [16,74]. One possible explanation is the incidence of stealth infections, which can cause severe damage to patients because TCZ obscures the symptoms of infection [75]. Overlooking early symptoms of infection such as cough, sputum, nasal discharge, or sore throat when receiving TCZ therapy in daily clinical practice is a problem.…”

Section: Safety Of the Il-6 Inhibitor In Ramentioning

confidence: 99%

IL-6 inhibitor for the treatment of rheumatoid arthritis: A comprehensive review

Ogata

Kato

Higa

et al. 2019

Modern Rheumatology

160

124

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Tocilizumab (TCZ) is an interleukin-6 (IL-6) inhibitor used for the treatment of rheumatoid arthritis (RA). It was developed in 2008, and its effectiveness is supported by evidence from all over the world based on its first decade of use. Although the overall efficacy and safety profiles of TCZ are similar to those of tumor necrosis factor (TNF) inhibitors, TCZ displays certain differences. The most notable advantage of TCZ is its usefulness as a monotherapy. Additionally, TCZ is favorable in the improvement of systemic inflammatory symptoms such as anemia and fatigue. The low immunogenicity of TCZ contributes favorably to long-term drug retention. Due to frequent relapse after TCZ cessation, TCZ use should be tapered beyond remission. During TCZ therapy, C-reactive protein (CRP) is unable to recognize disease activity and the severity of infection. The most common adverse events (AEs) are infection and abnormalities in laboratory findings including dyslipidemia, neutropenia, thrombocytopenia, and abnormality of liver enzymes. TCZ obscures the symptoms of infection. Therefore, stealth infections without obvious CRP elevation can sometimes cause severe damage to patients. Lower intestinal perforation is an uncommon but serious AE in TCZ therapy. Further clinical investigations will continue to refine the IL-6 inhibitory strategy.

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“…However, TCZ therapy may significantly alter the onset or clinical course of pneumonia. There are anecdotal reports that patients presenting with minimal clinical symptoms develop severe pneumonia with shock within 1 day of the start of TCZ therapy [ 25 ]. Sufficient evidence indicates that TCZ can suppress the elevation of CRP and fever even in infections.…”

Section: Introductionmentioning

confidence: 99%

Japan College of Rheumatology 2009 guidelines for the use of tocilizumab, a humanized anti-interleukin-6 receptor monoclonal antibody, in rheumatoid arthritis

et al. 2009

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The introduction of biological agents targeting tumor necrosis factor-alpha (TNF-α) has brought about a paradigm shift in the treatment of rheumatoid arthritis (RA). Although these anti-TNF agents have excellent efficacy against RA, a substantial number of patients still show inadequate responses. In Western countries, such patients are already being treated with new classes of antirheumatic drugs such as abatacept and rituximab. Tocilizumab (TCZ) is a humanized monoclonal antibody developed in Japan against the human interleukin-6 (IL-6) receptor. TCZ does not only alleviate the signs and symptoms of RA but also seems to prevent progressive bone and joint destruction. However, there is a concern that TCZ might increase the risk of adverse events such as infections since IL-6 plays a pivotal role in the immune system. Calculating the relative risks of specific adverse outcomes with TCZ use remains difficult, due to insufficient patient numbers enrolled in clinical trials to date. This review presents tentative guidelines for the use of TCZ for RA patients prepared by the Japan College of Rheumatology and based on results of clinical trials in Japan and Western countries. The guidelines are intended as a guide for postmarketing surveillance and clinical practice, and will be revised periodically based on the surveillance.

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Masked early symptoms of pneumonia in patients with rheumatoid arthritis during tocilizumab treatment: a report of two cases

Cited by 26 publications

References 16 publications

Efficacy and safety of tocilizumab in Korean patients with active rheumatoid arthritis

Efficacy and safety of tocilizumab in Korean patients with active rheumatoid arthritis

IL-6 inhibitor for the treatment of rheumatoid arthritis: A comprehensive review

Japan College of Rheumatology 2009 guidelines for the use of tocilizumab, a humanized anti-interleukin-6 receptor monoclonal antibody, in rheumatoid arthritis

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