Summary

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• This summary is based on the review of 34 systematic review(s)/meta-analysis(es). ^[1-33]
• Polymyalgia Rheumatica (PMR) and Giant Cell Arteritis (GCA): Tocilizumab was approved as a corticosteroid-sparing therapy for GCA, and Sarilumab was approved for PMR, showing effectiveness in managing these conditions.
• Systemic Juvenile Idiopathic Arthritis (JIA): Canakinumab demonstrated greater effectiveness than placebo (odds ratio (OR) = 55.0) in managing JIA, with Tocilizumab also included in efficacy analyses though ranking lower than Canakinumab.
• Rheumatoid Arthritis (RA): Tocilizumab showed effective symptom control in RA, particularly for patients with the AA genotype for the Interleukin 6 receptor (IL-6R) gene, achieving better American College of Rheumatology (ACR) 20 and ACR 50 response rates compared to Adalimumab in monotherapy.
• Sustained Remission in GCA: Tocilizumab maintained higher remission rates than placebo and standard corticosteroid tapering regimens, with weekly dosing being more effective than bi-weekly or placebo.
• General Safety: No significant differences in adverse events, including serious infections, were noted between Tocilizumab and other biologics or placebo, though infection was the most common adverse event in GCA treatments with Tocilizumab.
• Specific Risks: Tocilizumab in RA patients showed a significant risk of hepatitis B virus (HBV) reactivation, particularly in positive hepatitis B surface antigen (HBsAg(+)) patients without antiviral prophylaxis, with a reactivation rate of 69.4%. Increased cholesterol levels and a higher risk of lower gastrointestinal perforations were also associated with its use.
• Safety Profile in Comparative Studies: Tocilizumab demonstrated a comparable safety profile to other biologic disease-modifying anti-rheumatic drugs (bDMARDs) but with a higher risk of diverticulitis and gastrointestinal perforations compared to other treatments.
• Tocilizumab was primarily studied in RA and GCA patients, with specific subgroup considerations for patients with HBV infection in RA, IL-6R gene polymorphisms, and those aged 50 years or older with GCA, as well as JIA patients and RA patients intolerant to or inadequately responding to Methotrexate (MTX).