Leukoencephalopathy with cognitive impairment following tocilizumab for the treatment of rheumatoid arthritis (RA).
The biological agent tocilizumab, is a humanized, anti-human interleukin-6 receptor antibody. A 72-year-old woman developed cognitive impairment during the Phase III clinical trial of tocilizumab for the treatment of rheumatoid arthritis. MRI demonstrated hyperintense dissemination throughout the white matter on T2WI. An initial diagnosis of possible progressive multifocal leukoencephalopathy was made, but the PCR for JC virus DNA was negative in the CSF. The leukoencephalopathy might have been caused by a mechanism related to tocilizumab itself. It is strongly recommended to perform MRI if a patient develops any cognitive impairment during tocilizumab therapy.
Kobayashi
Katsuya
K
Department of Neurology, Kyoto University Hospital, Kyoto.
Okamoto
Yoko
Y
Inoue
Haruhisa
H
Usui
Takashi
T
Ihara
Masafumi
M
Kawamata
Jun
J
Miki
Yukio
Y
Mimori
Tsuneyo
T
Tomimoto
Hidekazu
H
Takahashi
Ryosuke
R
D000368:Aged; D000911:Antibodies, Monoclonal / Q000009:adverse effects*; D061067:Antibodies, Monoclonal, Humanized; D018501:Antirheumatic Agents / Q000009:adverse effects; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D003072:Cognition Disorders / Q000209:etiology*; D005260:Female; D006801:Humans; D007968:Leukoencephalopathy, Progressive Multifocal / Q000175:diagnosis / Q000209:etiology*; D008279:Magnetic Resonance Imaging; D019947:Receptors, Interleukin-6 / Q000037:antagonists & inhibitors
D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D018501:Antirheumatic Agents; D019947:Receptors, Interleukin-6; C502936:tocilizumab