• About
  • Privacy Policy
  • Terms Of Use
  • Contact
Sunday, February 5, 2023
Pharma Info Nepal
  • Home
  • Loksewa
  • License
  • Questions
  • Vacancy
  • Downloads
  • Notice
No Result
View All Result
  • Home
  • Loksewa
  • License
  • Questions
  • Vacancy
  • Downloads
  • Notice
No Result
View All Result
Pharma Info Nepal
No Result
View All Result
Home Updates

Tocilizumab|Uses|MOA|Side Effects 

Tocilizumab|Uses|MOA|Side Effects 

Nabin Bista by Nabin Bista
May 29, 2021
in Updates
0
Why Tocilizumab is being used in Corona Read here
404
VIEWS
Share on FacebookShare on Twitter

Tocilizumab|Uses|MOA|Side Effects 

Tocilizumab is an interleukin-6 (IL-6) receptor antagonist used to treat Cytokine Release Syndrome (CRS), Systemic Juvenile Idiopathic Arthritis (sJIA), Giant Cell Arteritis (GCA), and Rheumatoid Arthritis (RA).

Tocilizumab is a recombinant humanized monoclonal antibody IL-6 receptor inhibitor used to treat inflammatory and autoimmune conditions. It was first described in the literature in 2003 when Chugai, a subsidiary of Roche began developing IL-6 inhibiting monoclonal antibodies. It is currently being investigated to treat severely ill patients with COVID-19.

Tocilizumab was granted FDA approval on 8 January 2010.

Tocilizumab Indication

Tocilizumab is indicated to treat moderate to severe rheumatoid arthritis, giant cell arteritis, polyarticular juvenile idiopathic arthritis, systemic juvenile idiopathic arthritis, and cytokine release syndrome.

  • Rheumatoid arthritis

Tocilizumab is used for the treatment of moderate to severe rheumatoid arthritis, applied in combination with methotrexate, if other drugs like disease-modifying antirheumatic drugs (DMARDs) and TNF alpha blockers have proven to be ineffective or were not tolerated. It can be used as a monotherapy for patients who do not tolerate methotrexate. The drug slows down the progression of the disease and can improve physical function of patients.

  • Systemic juvenile idiopathic arthritis

The treatment of systemic juvenile idiopathic arthritis is similar to RA treatment: tocilizumab is combined with methotrexate unless the latter is not tolerated. General safety and effectiveness is established for children of two years and older.

In 2011 the US FDA approved tocilizumab for the treatment of the orphan disease, active systemic juvenile idiopathic arthritis (SJIA), a rare and severe form of arthritis affecting children.

  • Castleman’s disease

In Japan, tocilizumab is also approved for the treatment of Castleman’s disease, a rare benign tumor of B cells.

  • Neuromyelitis optica

Early case reports suggest tocilizumab might be effective in otherwise refractory neuromyelitis optica (NMO, Devic’s disease).

  • Giant cell arteritis

In May 2017, tocilizumab was FDA approved for giant cell (temporal) arteritis.

  • Cytokine release syndrome

On 30 August 2017, the FDA approved tocilizumab for cytokine release syndrome, a side effect of CAR-T cell therapies.

  • COVID-19

The pathogenesis of the acute pulmonary treatment injury related to COVID-19 is related to a severe hyperinflammatory state with high amounts of pro-inflammatory cytokines such as IL-6, IL-1, IL-2, and TNF-α. Preliminary trial data has suggested that tocilizumab may be effective in improving outcomes for patients severely affected by the SARS-CoV-2 virus; REMAP-CAP trial has provided sufficient evidence for it to be added to the approved list.

Tocilizumab Pharmacodynamics

Tocilizumab is an IL-6 inhibiting monoclonal antibody used to treat autoimmune and inflammatory conditions.6 Tocilizumab has a long duration of action as it is generally given every 4 weeks and has a wide therapeutic index.6 Patients should be counselled regarding the risk of infections, GI perforation, and hepatotoxicity.

Tocilizumab Mechanism of action

Interleukin 6 (IL-6) is a pro-inflammatory cytokine produced by cells including T-cells, B-cells, lymphocytes, monocytes, fibroblasts.6 IL-6 rapidly induces C-reactive protein, serum amyloid A, fibrinogen, haptoglobin, and a-1-antichymotrypsin while inhibiting production of fibronectin, albumin, and transferrin.4 IL-6 also induces antibody production, induces cytotoxic T-cell differentiation, and inhibits regulatory T-cell differentiation. Tocilizumab binds soluble and membrane bound IL-6 receptors, preventing IL-6 mediated inflammation.

Tocilizumab Adverse effects

The most common adverse effects observed in clinical trials were

  • Upper respiratory tract infection (6-8%
  • Nasopharyngitis (4-7%)
  • Headache (3-7%)
  • Hypertension (3-6%)
  • ALT increased (1-6%)
  • Bronchitis (2-4%)
  • Rash (1-4%)
  • Dizziness (1-3%)
  • Mouth ulceration (1-2%)
  • Upper abdominal pain (2-3%)
  • Gastritis (1-2%)
  • Oral herpes simplex (<2%)
  • Stomatitis (<2%)
  • Gastric ulcer (<2%)
  • Increased weight (<2%)
  • Total bilirubin increased (<2%)
  • Leukopenia (<2%)
  • Peripheral edema (<2%)
  • Dyspnea (<2%)
  • Cough (<2%)
  • Conjunctivitis (<2%)

COVID-19

China’s National Health Commission included the use of tocilizumab in guidelines to treat coronavirus disease 2019 (COVID-19) patients. In March 2020, China approved tocilizumab for the treatment of inflammation in patients with the coronavirus SARS-CoV-2. As of June 2020, there is no evidence whether this treatment is effective. Chinese health officials say that only 21 patients have been asked to use this medicine. The same month, a randomized study, at 11 locations in China was conducted to compare favipiravir versus tocilizumab versus both.

On 11 March 2020, Italian physician Paolo Ascierto reported that tocilizumab appeared to be effective in three severe cases of COVID-19 in Italy. On 14 March 2020, three of the six treated patients in Naples had shown signs of improvement prompting the Italian Pharmacological Agency (AIFA) to expand testing in five other hospitals Roche and the WHO have each launched separate trials for its use in severe COVID-19 cases.

Tocilizumab was among the drugs noted as treatments for COVID-19 in a study of major hospitals in the U.S. that determined that abnormal liver tests were occurring in most hospitalized patients with COVID-19 and may be associated with poorer clinical outcomes. Several medications used in the treatments during the study were found to be associated with peak hospitalization liver transaminase elevations >5x ULN. Tocilizumab was significantly associated in the relationship between the drugs used to treat the disease and abnormal liver tests, which has prompted studies being conducted to determine whether the abnormal tests were due to the disease or to drug-induced liver injury, according to Michael Nathanson, director of the Yale Liver Center and co-author of the study.

Roche announced on July 29, 2020 that its randomized double-blind trial of tocilizumab in the treatment of pneumonia in COVID-19 patients had shown a reduction in hospitalization time in patients treated with tocilizumab. However, tocilizumab treatment did not meet its primary endpoint of improved clinical status of patients with COVID-19 associated pneumonia, nor its key secondary endpoint of reduced patient mortality.

In October 2020, another research was published that concluded that “tocilizumab was not effective for preventing intubation or death in moderately ill hospitalized patients with Covid-19”.

In November 2020, press reports stated that early results from the REMAP-CAP trial conducted jointly by Imperial College London, the Intensive Care National Audit and Research Centre and Utrecht University had shown promising results in patients with severe COVID-19.

In January 2021, the REMAP-CAP trial released preliminary evidence that tocilizumab and sarilumab could reduce fatalities among severely ill Covid-19 patients. The drugs were added to the UK recommended list for COVID-19 treatment. The following month, the RECOVERY Trial revealed a similar result: 29% of the patients in the tocilizumab group died within 28 days compared with 33% in the usual care group, a statistically significant reduction of the risk of death on top of the reduction already given by dexamethasone. It also reduced the chance of a patient needing to go on a ventilator or dying from 38% to 33%. Researchers reported that tocilizumab and dexamethasone combined should cut death risk by about a third for patients on oxygen and halve it for those on a ventilator.

For more information please follow monograph of Tocilizumab

FDA Tocilizumab Monograph

References:

  • https://en.wikipedia.org/wiki/Tocilizumab
  • https://reference.medscape.com/drug/actemra-tocilizumab-999419#4
  • https://www.cdc.gov/coronavirus/2019-ncov/hcp/therapeutic-options.html


 

Tags: Medicine Information
Previous Post

DDA Notice Regarding Distribution of Tocilizumab Injection (Actemra) 400mg/20 ml

Next Post

Pharmacology Facts Every Pharmacist Should Know

Nabin Bista

Nabin Bista

Hello, Thank You for visiting my blog I am Nabin Bista, Dedicated and self motivated young Pharmacist from Nepal. Blogging is my passion. I am studying B Pharmacy at Institute of Medicine - IOM. If you want me to write about any posts that you found confusing/difficult, please mention in the comments below.

Related Posts

Pharma Info Nepal | Nepal's No. 1 Pharmacy Blog

Drug and Medicine Related Act, Rules, Regulations, Policies, Guidelines & Directives in Nepal

February 1, 2023
FDA-Approved HIV Medicines

FDA Approved HIV Medicines

January 26, 2023
Combined Oral Contraceptives (COC)

Combined Oral Contraceptives (COC)

January 17, 2023
Novel Drug Approvals for 2022

Novel Drug Approvals for 2022

January 3, 2023
Load More
Next Post
Pharmacology Facts Every Pharmacist Should Know

Pharmacology Facts Every Pharmacist Should Know

Discussion about this post

Recommended

Nepal Pharmacy Council Notice 

Nepal Pharmacy Council Notice Regarding Good Standing Letter / No objection Letter / Eligibility Certificate

2 years ago
Loksewa Aayog Pharmacy Supervisor Vacancy Announcement

Loksewa Aayog Pharmacy Supervisor Vacancy Announcement

2 years ago

Don't Miss

Ethical Guidelines for the Care and Use of Animals in Health Research in Nepal

Ethical Guidelines for the Care and Use of Animals in Health Research in Nepal

February 4, 2023
Pharma Info Nepal | Nepal's No. 1 Pharmacy Blog

Drug and Medicine Related Act, Rules, Regulations, Policies, Guidelines & Directives in Nepal

February 1, 2023
Vacancy Announcement Assistant Professor Pharmacy and Medicine Dispenser 

Vacancy Announcement Assistant Professor Pharmacy and Medicine Dispenser 

February 1, 2023
FDA-Approved HIV Medicines

FDA Approved HIV Medicines

January 26, 2023

About Pharma Info Nepal

Pharma Info Nepal (Nabin’s Blog) was initiated in 2019 with the aim of providing relevant and accurate information for pharmacy, nursing and other health professionals. Since then it is conveying health related educational and informational updates of Nepal. It serves as a source for learning materials on diverse topics relating to medicine intended basically for pharmacy and nursing students. It covers job opportunities, question collections for pharmacy license, nursing license as well as various competitive exams.

Our readers rely on us for the well referenced and latest updates collected from the reliable sites.

Follow us

  • Facebook
  • Twitter
  • LinkedIn
  • YouTube
  • Instagram

Information Reader

Contents (text, image, graphics, documents and other materials) published on this portal are collected from other relevant sources with the sole purpose of sharing information. Contents and features are subject to change and all rights reserved to Pharma info Nepal. The information presented on this web portal and its official social media handles have no affiliation to any organization that author is involved with either professionally or personally.

If you have found anything displayed incorrectly or have further suggestions on improving our effort, please do not hesitate to reach out at pharmainfonepal1@gmail.com !
We hope you find Pharma info Nepal a helpful site. Thanks !!!

Categories

  • B Pharmacy
  • Colleges
  • D Pharmacy
  • Downloads
  • License
  • Loksewa
  • M Pharmacy
  • Medicinal Chemistry
  • Notice
  • Nursing
  • Pharmacognosy
  • Pharmacology
  • Questions
  • Scholarship
  • Study Materials
  • Syllabus
  • Updates
  • Vacancy

DOWNLOADS

Pharmacy Book 

Pharmacy Act and Guidelines

About Pharma Info Nepal

About Admin

  • About
  • Privacy Policy
  • Terms Of Use
  • Contact

© 2021 Nabin's Blog

No Result
View All Result
  • Home
  • Loksewa
  • License
  • Questions
  • Vacancy
  • Downloads
  • Notice

© 2021 Nabin's Blog

error: