Background A novel target for the treatment of rheumatoid arthritis (RA) is cytokine interleukin-6 (IL-6), a key pro-inflammatory cytokine in RA contributing to both the articular and systemic manifestations of the disease.

Purpose To describe the efficacy and safety of tocilizumab, an IL-6 receptor antibody, in RA.

Materials and methods Retrospective review of all patients treated with tocilizumab since its market launch between November 2009 and April 2011 in a regional hospital. Data collected from the management system software were: age, sex, treatment duration, previous treatments with biologicals, acute phase reactants (erythrocyte sedimentation rate (ESR), C-reactive protein (CRP)), laboratory findings and adverse events.

Results 12 patients (10 women, 2 men) were included. Mean age was 52 years (range 35 – 69). Mean treatment duration was 8 months (range 2-18). 10 patients had previously been treated with biotherapy (4 adalimumab, 2 etanercept, 1 adalimumab and abatacept, and 3 patients with 3 biologicals). Evolution of median acute phase reactants as efficacy end points was:

ESR 62.5% reduction (from 32 mm/h at the beginning of treatment to 12 mm/h at the end of the study). CRP: 86% reduction (from 12.6 mg/L to 1.8 mg/L). Hepatic transaminases, lipid parameters and neutrophils were normal. 4 of 12 patients discontinued tocilizumab treatment (1 for lack of efficacy, 2 for adverse events and 1 for another reason). Adverse events were facial hyperaemia and dysaesthesias in arm and fingers.

Conclusions In this study tocilizumab showed a positive benefit-risk ratio in RA.

Major limitations were low number of patients and lack of long term safety data.