Risk of infections in rheumatoid arthritis patients treated with tocilizumab

Lang, Veronika; Englbrecht, Matthias; Rech, Jürgen; Nüßlein, H.; Manger, Karin; Schuch, Florian; Tony, Hans‐Peter; Manger, Bernhard; Schett, Georg; Zwerina, Jochen

doi:10.1093/rheumatology/ker223

Cited by 105 publications

(78 citation statements)

References 23 publications

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“…Such infections may cause severe morbidity and even mortality (14). Recently, not only post-transplant patients, but also those taking biological agents (i.e., RA patients) such as tocilizumab and anti-TNF-α antibodies (which are widely recognized to be safe and efficacious), have been shown to be at risk of various infections (15). When such agents are pre- scribed, surveillance for infection with, for example, Mycobacterium tuberculosis is essential (16).…”

Section: Discussionmentioning

confidence: 99%

Cytomegalovirus Reactivation Induced Acute Hepatitis and Gastric Erosions in a Patient with Rheumatoid Arthritis under Treatment with an Anti-IL-6 Receptor Antibody, Tocilizumab

et al. 2016

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Tocilizumab, an anti-human interleukin 6 receptor (IL-6R) monoclonal antibody, is widely used to treat rheumatoid arthritis (RA) and is expected to exhibit clinical efficacy when used to treat other autoimmune diseases. However, a risk of opportunistic infection is occasionally recognized. A 54-year-old woman had received an oral corticosteroid and methotrexate to treat RA. Despite receiving these treatments, she received additional treatment with tocilizumab due to poor control of the disease activity. She presented at our hospital with a high fever and epigastralgia 19 days after receiving this treatment. A laboratory evaluation revealed liver injury and cytomegalovirus (CMV) viremia. Abdominal ultrasonography and computed tomography (CT) revealed hepatosplenomegaly, but no ascites. Upper gastrointestinal endoscopy revealed gastric erosions induced by CMV, which were confirmed immunohistochemically. Hence, we diagnosed the patient with CMV reactivation-induced acute hepatitis and gastric erosions under tocilizumab treatment. She received an anti-cytomegalovirus drug, ganciclovir, for 14 days due to her viremia and impaired general condition, which was suggestive of a severe infection. Her general condition subsequently improved, the liver function test results normalized, and the gastric erosions disappeared. In conclusion, although tocilizumab is very useful for treating certain autoimmune and inflammatory diseases, and will be prescribed more widely in the future, associated CMV infections must be closely monitored, as these can be lethal.

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Section: Discussionmentioning

confidence: 99%

Cytomegalovirus Reactivation Induced Acute Hepatitis and Gastric Erosions in a Patient with Rheumatoid Arthritis under Treatment with an Anti-IL-6 Receptor Antibody, Tocilizumab

et al. 2016

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“…Treatment with a small molecule STAT3 inhibitor (AG490) also decreased hepcidin and increased serum iron in healthy mice. 86 Although anti-cytokine therapies are effective in lowering hepcidin production, their side effects include increased risk of infection due to impaired host defense, 87,88 thus these types of therapies may be confined to the treatment of severe inflammatory diseases.…”

Section: E Fung Et Almentioning

confidence: 99%

Manipulation of the hepcidin pathway for therapeutic purposes

2013

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“…Consequently, infections are at risk of a late diagnosis because of the masking effect. Despite the therapy with TCZ at the moment of infection, the reported patient had an actual and past of immunosuppressors that rise the cumulative risk of serious infection in association to a longer disease duration and previous use of rituximab which are identified as predictors of infection [9]. The actual contribution of TCZ to infection susceptibility is yet to know, as its use experience rises.…”

Section: Discussionmentioning

confidence: 99%

“…Most of the serious infections described are bacterial and viral, with no uncommon pathogens. Also, a longer disease duration, higher number of previous DMARDs and previous use of rituximab are identified as predictors of infection [9].…”

Section: Introductionmentioning

confidence: 98%

Cerebral Nocardiosis in a Patient With Rheumatoid Arthritis Under Treatment With Tocilizumab

et al. 2018

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The use of biological therapy has revolutionized the treatment of various autoimmune diseases. Tocilizumab (TCZ) is a recombinant humanized antiinterleukin-6 (IL-6) receptor monoclonal antibody approved for the treatment of patients with rheumatoid arthritis, as monotherapy or in combination with other disease-modifying antirheumatic drugs (DMARDs). Clinical and post-marketing surveillance studies of TCZ indicate that infections are the most frequent adverse events. Most of the serious infections described are bacterial and viral, with no uncommon pathogens. The authors report a case of a patient with destructive rheumatoid arthritis under TCZ that presented with neurological symptoms and a right cerebellar lesion with marked diffusion restriction suggestive of cerebellar abscess. The microbiologic studies from aspirative cerebral biopsy revealed Nocardia farcinica. With adequate antibiotics, the patient evolved with resolution of all symptoms and brain abscess at 5 months of followup. According to published reports, this is the first case of nocardial infection in patients under TCZ. The case highlights the importance of being aware of risk infection in these patients and need of an early diagnosis allowing a prompt treatment.

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Risk of infections in rheumatoid arthritis patients treated with tocilizumab

Cited by 105 publications

References 23 publications

Cytomegalovirus Reactivation Induced Acute Hepatitis and Gastric Erosions in a Patient with Rheumatoid Arthritis under Treatment with an Anti-IL-6 Receptor Antibody, Tocilizumab

Cytomegalovirus Reactivation Induced Acute Hepatitis and Gastric Erosions in a Patient with Rheumatoid Arthritis under Treatment with an Anti-IL-6 Receptor Antibody, Tocilizumab

Manipulation of the hepcidin pathway for therapeutic purposes

Cerebral Nocardiosis in a Patient With Rheumatoid Arthritis Under Treatment With Tocilizumab

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