Rheumatology Book

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Interleukin-6 Receptor Antagonist

Aka: Interleukin-6 Receptor Antagonist, Anti-IL6 monoclonal antibody, Tocilizumab, Actemra, Sarilumab, Kevzara, Siltuximab, Sylvant
  1. Mechanism
    1. Blockade of of IL-6 decreases production of proinflammatory Cytokines and acute phase reactants
  2. Indications
    1. Severe Cytokine Release Syndrome (CRS)
      1. CAR T-Cell Therapy Related CRS (FDA approved use of Tocilizumab)
      2. COVID-19 related CRS (experimental Tocilizumab use in 2020)
    2. Multicentric Castleman’s disease (Siltuximab)
    3. Rheumatologic Conditions (Tocilizumab)
      1. Rheumatoid Arthritis
      2. Giant Cell Arteritis
      3. Polyarticular Juvenile Idiopathic Arthritis
      4. Systemic Juvenile Idiopathic Arthritis
  3. Preparations
    1. Tocilizumab
      1. IL-6 receptor antagonist (Monoclonal Antibody)
      2. Cytokine Release Syndrome Dosing: 8 mg/kg (up to 800 mg) or for <30 kg, use 12 mg/kg
    2. Sarilumab (Kevzara)
    3. Siltuximab (Sylvant)
      1. Binds IL-6 (Monoclonal Antibody)
  4. Adverse Effects
    1. Severe infections (esp. opportunistic Viral Infections, Bacterial Infections, invasive fungal infections)
    2. Reactivated Herpes Zoster
    3. Reactivated Tuberculosis
    4. Neutropenia
    5. Thrombocytopenia
    6. Increased liver enzymes
    7. Hyperlipidemia
    8. GI perforation
  5. References
    1. Kamer and LoVecchio (2020) Crit Dec Emerg Med 34(8): 24

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