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ABSTRACT
Tocilizumab (TCZ), is a recombinant humanized anti-interleukin-6 receptor (IL-6R) monoclonal antibody which has a main use in the treatment of rheumatoid arthritis, systemic juvenile idiopathic arthritis (sJIA) and polyarticular juvenile idiopathic arthritis (pJIA). This article provides an overview of TCZ including looking into the past at the discovery of interleukin-6 (IL-6) as a pro-inflammatory cytokine. It also looks at how tocilizumab was developed, manufactured and tested to ensure both safety and efficacy in a human population. The article then explores the advantages and disadvantages of using TCZ when compared to other biologics approved in RA, sJIA and pJIA and finally looks ahead to the future and the emerging role of IL-6 and its blockade by TCZ as a treatment for giant cell arteritis (GCA), polymyalgia rheumatica (PMR) and large vessel vasculitis (LVV).
Abbreviations
| ABC | = | Abatacept |
| ACR | = | American College of Rheumatology |
| ADA | = | Adalimumab |
| AE | = | Adverse Event |
| ANC | = | Absolute neutrophil count |
| ANK | = | Anakinra |
| AUC | = | Area under the curve |
| CHO | = | Chinese Hamster Ovary |
| CHMP | = | Committee for Medicinal Products for Human Use |
| Cmax | = | Maximum concentration of TCZ in the plasma |
| CRP | = | C Reactive Protein |
| CTL | = | Certolizumab Pegol |
| CV | = | Cardiovascular |
| CYP450 | = | Cytochrome P450 Enzyme |
| DAS | = | Disease Activity Score |
| DMARDs | = | Disease-Modifying Anti-Rheumatic Drugs |
| EMA | = | European Medicines Agency |
| EPAR | = | European Public Assessment Report |
| ETA | = | Etanercept |
| EU | = | European Union |
| FAB | = | Fragment Antigen Binding |
| GC | = | Glucocorticoids |
| GCA | = | Giant Cell Arteritis |
| GOL | = | Golimumab |
| HDL | = | High Density Lipoprotein |
| IL-6 | = | Interleukin 6 |
| IL-6R | = | Interleukin 6 receptor |
| IL-17 | = | Interleukin 17 |
| INX | = | Infliximab |
| IV | = | Intravenous |
| JAKs | = | Janus kinases |
| LDL | = | Low Density Lipoprotein |
| LVV | = | Large Vessel Vasculitis |
| MAPK | = | Mitogen-Activated Protein Kinases |
| MMP | = | Matrix Metalloproteinase |
| MTX | = | Methotrexate |
| NSAID | = | Non-Steroidal Anti Inflammatory Drug |
| pJIA | = | Polyarticular Juvenile Idiopathic Arthritis |
| PMR | = | Polymyalgia Rheumatica |
| RA | = | Rheumatoid Arthritis |
| RANKL | = | Nuclear Factor Kappa B Ligand |
| RTX | = | Rituximab |
| SC | = | Subcutaneous |
| sJIA | = | Systemic Juvenile Idiopathic Arthritis |
| SmPC | = | Summary of Product Characteristics |
| TA | = | Takayasu Arteritis |
| TCZ | = | Tocilizumab |
| TC | = | Total Cholesterol |
| Th17 | = | T helper 17 cells |
| TGF-β | = | Transforming Growth Factor Beta |
| TNF-α | = | Tumour necrosis factor alpha |
| Treg | = | Regulatory T-cells |
| USA | = | United States of America |
| US | = | Ultrasound. |
| VEGF | = | Vascular Endothelial Growth Factor |
Disclosure of potential conflicts of interest
No potential conflicts of interest were disclosed.