Summary

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• Actemra (tocilizumab) is indicated for the treatment of rheumatoid arthritis (RA) in adult patients with moderately to severely active rheumatoid arthritis who have had an inadequate response to one or more disease-modifying anti-rheumatic drugs (DMARDs); the treatment of giant cell arteritis (GCA) in adult patients with giant cell arteritis; the treatment of systemic sclerosis-associated interstitial lung disease (SSc-ILD) for slowing the rate of decline in pulmonary function in adult patients with systemic sclerosis-associated interstitial lung disease (SSc-ILD); the treatment of polyarticular juvenile idiopathic arthritis (PJIA) in patients 2 years of age and older with active polyarticular juvenile idiopathic arthritis; the treatment of systemic juvenile idiopathic arthritis (SJIA) in patients 2 years of age and older with active systemic juvenile idiopathic arthritis; the treatment of cytokine release syndrome (CRS) in adults and pediatric patients 2 years of age and older with chimeric antigen receptor (CAR) T cell-induced severe or life-threatening cytokine release syndrome; and the treatment of coronavirus disease 2019 (COVID-19) in hospitalized adult patients with coronavirus disease 2019 (COVID-19) who are receiving systemic corticosteroids and require supplemental oxygen, non-invasive or invasive mechanical ventilation, or extracorporeal membrane oxygenation (ECMO).
• This summary is based on the review of 93 systematic review(s)/meta-analysis(es). ^[1-95]
• Systemic Sclerosis-Associated Interstitial Lung Disease (SSc-ILD): Tocilizumab led to a reduction in disease progression, with a 66% lower risk of a >10% decrease in FVC% predicted compared to placebo.
• Rheumatoid Arthritis (RA): Tocilizumab significantly reduced oral glucocorticoid use compared to TNF-inhibitors and abatacept and was particularly effective in genetic subgroups with the IL-6R rs12083537 AA genotype.
• COVID-19: Tocilizumab was associated with reduced 28-day mortality, decreased need for mechanical ventilation, and higher hospital discharge rates compared to standard of care, with improved outcomes particularly in non-intubated severe cases.
• Giant Cell Arteritis (GCA): Tocilizumab reduced the risk of relapse and serious adverse events compared to methotrexate and glucocorticoid use, effectively achieving sustained remission and lowering the need for escape therapy.
• Rheumatoid Arthritis (RA): Tocilizumab resulted in increased lipid profiles but no significant difference in the incidence of serious adverse events compared to other treatments. Genetic markers indicated variability in safety outcomes.
• COVID-19: Tocilizumab was associated with a higher incidence of adverse reactions, including secondary infections, thrombotic and bleeding events, and acute liver injury, compared to baricitinib. However, it did not significantly increase the risk of serious adverse events or infections compared to standard of care.
• Giant Cell Arteritis (GCA): Tocilizumab had a safety profile comparable to other glucocorticoid-sparing agents, with no significant increase in serious adverse events.
• Subgroups based on genetic polymorphisms, particularly IL-6R SNPs in Rheumatoid Arthritis (RA) patients, exhibited variable responses and safety profiles, with the IL-6R rs12083537 AA genotype showing a better treatment response to tocilizumab, suggesting personalized treatment considerations.
• In COVID-19, tocilizumab was more effective in severe non-intubated cases and patients receiving corticosteroids, indicating the importance of patient selection for optimal outcomes.