title: Efficacy of the anti-IL-6 receptor antibody tocilizumab in neuromyelitis optica: a pilot study.
abstract: OBJECTIVE
  To evaluate the safety and efficacy of a humanized anti-interleukin-6 receptor antibody, tocilizumab (TCZ), in patients with neuromyelitis optica (NMO).
  
  
  METHODS
  Seven patients with anti-aquaporin-4 antibody (AQP4-Ab)-positive NMO or NMO spectrum disorders were recruited on the basis of their limited responsiveness to their current treatment. They were given a monthly injection of TCZ (8 mg/kg) with their current therapy for a year. We evaluated the annualized relapse rate, the Expanded Disability Status Scale score, and numerical rating scales for neurogenic pain and fatigue. Serum levels of anti-AQP4-Ab were measured with AQP4-transfected cells.
  
  
  RESULTS
  Six females and one male with NMO were enrolled. After a year of TCZ treatment, the annualized relapse rate decreased from 2.9 ± 1.1 to 0.4 ± 0.8 (p < 0.005). The Expanded Disability Status Scale score, neuropathic pain, and general fatigue also declined significantly. The ameliorating effects on intractable pain exceeded expectations.
  
  
  CONCLUSIONS
  Interleukin-6 receptor blockade is a promising therapeutic option for NMO.
  
  
  METHODS
  This study provides Class IV evidence that in patients with NMO, TCZ reduces relapse rate, neuropathic pain, and fatigue.
authors.affiliation: From the Multiple Sclerosis Center (M.A., T.O., S.M., T.A., T.Y.) and Department of Neurology (T.O., M.M.), National Center Hospital, and Department of Immunology, National Institute of Neuroscience (T.M., S.M., T.A., T.Y.), National Center of Neurology and Psychiatry, Tokyo; Department of Neurology (K.M., S.K.), Kinki University School of Medicine, Osaka; and Department of Pediatrics (T.M.), Graduate School of Medicine, University of Tokyo, Japan.
authors.forename: Manabu
authors.initials: M
authors.lastname: Araki
authors.forename: Takako
authors.initials: T
authors.lastname: Matsuoka
authors.forename: Katsuichi
authors.initials: K
authors.lastname: Miyamoto
authors.forename: Susumu
authors.initials: S
authors.lastname: Kusunoki
authors.forename: Tomoko
authors.initials: T
authors.lastname: Okamoto
authors.forename: Miho
authors.initials: M
authors.lastname: Murata
authors.forename: Sachiko
authors.initials: S
authors.lastname: Miyake
authors.forename: Toshimasa
authors.initials: T
authors.lastname: Aranami
authors.forename: Takashi
authors.initials: T
authors.lastname: Yamamura
mesh_terms: D000328:Adult; D061067:Antibodies, Monoclonal, Humanized / Q000009:adverse effects / Q000627:therapeutic use*; D005221:Fatigue / Q000188:drug therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009437:Neuralgia / Q000188:drug therapy; D009471:Neuromyelitis Optica / Q000188:drug therapy*; D010865:Pilot Projects; D019947:Receptors, Interleukin-6 / Q000037:antagonists & inhibitors*; D055502:Secondary Prevention; D016896:Treatment Outcome
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D019947:Receptors, Interleukin-6; C502936:tocilizumab