Successful use of interleukin 6 antagonist tocilizumab in a patient with refractory cutaneous lupus and urticarial vasculitis

Ashima Makol, Lawrence E. Gibson, Clement Michet

Research output: Contribution to journalArticle

38 Citations (Scopus)

Abstract

Tocilizumab (Actemra; Genentech, Inc) is the first biologic therapy targeting the cytokine interleukin 6 (IL-6). It is a humanized monoclonal immunoglobulin G1 antibody against the α-chain of the IL-6 receptor that prevents the binding of IL-6 to membrane-bound and -soluble IL-6 receptor. It was approved by the US Food and Drug Administration in January 2010 for rheumatoid arthritis refractory to other approved therapies and in April 2011 for systemic juvenile idiopathic arthritis. It has been used as an off-label treatment in many autoimmune diseases, where IL-6 plays a major role in pathogenesis. We report a case of refractory systemic lupus erythematosus in a 22-year-old woman with recurrent high-grade fever, polyarthritis, diffuse rash with urticarial vasculitis, and tumid lupus who did not respond to topical corticosteroids, photoprotection, antimalarials, methotrexate, anakinra, mycophenolate mofetil, etanercept, and intravenous immunoglobulin therapy. Symptoms recurred after corticosteroid tapers below 10 mg. She was noted to have an elevated IL-6 level, and tocilizumab was started. She responded favorably with remission of fever, arthritis, and skinmanifestations and was able to taper corticosteroid therapy successfully.

Original languageEnglish (US)
Pages (from-to)92-95
Number of pages4
JournalJournal of Clinical Rheumatology
Volume18
Issue number2
DOIs
StatePublished - Mar 2012

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Vasculitis
Interleukin-6
Interleukin-6 Receptors
Skin
Adrenal Cortex Hormones
Arthritis
Fever
Interleukin 1 Receptor Antagonist Protein
Mycophenolic Acid
Biological Therapy
Passive Immunization
Juvenile Arthritis
Intravenous Immunoglobulins
Antimalarials
United States Food and Drug Administration
Exanthema
Methotrexate
Systemic Lupus Erythematosus
Autoimmune Diseases
Immunoglobulins

Keywords

  • Biologics
  • Cutaneous lupus
  • IL-6
  • SLE
  • Tocilizumab

ASJC Scopus subject areas

  • Rheumatology

Cite this

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