A Novel Application for a Rheumatologic Medication

Abstract

Rheumatology has enjoyed significant advances in pharmacotherapy over the past two decades. Now, with our arsenals buffered, we ask, “Can these novel anti-rheumatic drugs escape the niche of rheumatology? Is their utility beyond the joints and autoimmunological processes? Say perhaps, myocardial infarctions?”Enter tocilizumab (Actemra®). Tocilizumab is a novel humanized monoclonal anti-body approved by the US Food and Drug Administration in 2010 for the treatment of rheu-matoid arthritis and (later) juvenile idiopathic arthritis. The drug is administered as either a monthly intravenous infusion or as a weekly (or every other week) subcutaneous injection. The dose of the monthly infusion can vary between 4 mg/kg and 8 mg/kg but the once a week or every other week injection is 162 mg subcutaneously. In patients with rheumatoid arthritis, interleukin 6 (IL-6) is overproduced in the body, causing fatigue, anemia, inflammation and damage to bones, cartilage and tissue. Acting as an antagonist of IL-6 receptors, tocilizumab in-terferes with the pro-inflammatory effects of the IL-6–IL-6 receptor interaction. This response can be objectively gauged with serum C-Reactive Protein (CRP), offering a clinically practical and quantitative measure of inflammation.