Excellent therapeutic effect of tocilizumab on intestinal amyloid a deposition secondary to active rheumatoid arthritis.
A 64-year-old woman suffering from progressive amyloid A (AA) amyloidosis of the gastrointestinal (GI) tract, associated with active rheumatoid arthritis, was transferred to our hospital due to hypovolemic shock. Although intensive care, including treatment with prednisolone and methotrexate, improved the hypovolemic shock, paralytic ileus became dominant instead of the marked diarrhea, suggesting the terminal stage of AA amyloidosis of the GI tract. Thus, we administered tocilizumab, a humanized anti-interleukin 6 receptor antibody (8 mg/kg, repeated every 4 weeks). Two weeks after the first injection of tocilizumab, serum AA rapidly returned to their normal ranges in accordance with the amelioration of paralytic ileus and systemic joint pain. Surprisingly, after three courses of tocilizumab treatment, colon biopsy revealed no amyloid deposition. Tocilizumab is a promising agent to treat secondary AA amyloidosis by strongly suppressing serum AA levels.
Department of Hematology and Clinical Immunology, Kobe City Medical Center General Hospital, 4-6 Minatojima-Nakamachi, Chuo-ku, Kobe 650-0046, Japan.
Daichi
D
Inoue
Hiroshi
H
Arima
Chiharu
C
Kawanami
Yoko
Y
Takiuchi
Seiji
S
Nagano
Takaharu
T
Kimura
Sonoko
S
Shimoji
Minako
M
Mori
Sumie
S
Tabata
Soshi
S
Yanagita
Akiko
A
Matsushita
Kenichi
K
Nagai
Yukihiro
Y
Imai
Takayuki
T
Takahashi
D000686:Amyloidosis / Q000209:etiology / Q000473:pathology / Q000628:therapy*; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized; D001172:Arthritis, Rheumatoid / Q000150:complications* / Q000473:pathology / Q000628:therapy; D005260:Female; D006801:Humans; D007410:Intestinal Diseases / Q000209:etiology / Q000473:pathology / Q000628:therapy*; D007422:Intestines / Q000473:pathology*; D008875:Middle Aged; D019947:Receptors, Interleukin-6 / Q000037:antagonists & inhibitors; D016896:Treatment Outcome
D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D019947:Receptors, Interleukin-6; C502936:tocilizumab