title: Subcutaneous tocilizumab for the treatment of rheumatoid arthritis.
abstract: Rheumatoid arthritis (RA) is characterized by inflammatory synovitis and is mediated by several cytokines; this includes interleukin-6, whose receptor has been successfully targeted by the humanized monoclonal antibody tocilizumab. Intravenous tocilizumab (TCZ-IV) is registered for use in RA (alone or as combination therapy), systemic juvenile idiopathic arthritis and Castleman disease. Subcutaneous tocilizumab (TCZ-SC) is a desirable alternative to existing subcutaneous biological disease modifying antirheumatic drugs (bDMARDs) targeting tumor necrosis factor. TCZ-SC efficacy has been evaluated in three randomized controlled trials. BREVACTA demonstrated superiority to placebo, and both MUSASHI and SUMMACTA demonstrated non-inferiority to TCZ-IV. TCZ-SC has a similar safety profile to TCZ-IV apart from increased rates of injection site reactions and development of anti-TCZ antibodies (the latter of uncertain clinical significance). TCZ-SC 162 mg fortnightly is equivalent to TCZ-IV 4 mg/kg fourth weekly; TCZ-SC 162 mg weekly is equivalent to TCZ-IV 8 mg/kg fourth weekly. TCZ-SC is a suitable bDMARD for RA, particularly when monotherapy is preferred.
authors.affiliation: a Department of Rheumatology , Royal Hobart Hospital , Hobart , Australia.
authors.forename: Emma
authors.initials: E
authors.lastname: Mitchell
authors.affiliation: b Menzies Institute for Medical Research , University of Tasmania , Hobart , Australia.
authors.forename: Graeme
authors.initials: G
authors.lastname: Jones
mesh_terms: D061067:Antibodies, Monoclonal, Humanized / Q000008:administration & dosage / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy* / Q000276:immunology; D006801:Humans; D007279:Injections, Subcutaneous; D016032:Randomized Controlled Trials as Topic; D019947:Receptors, Interleukin-6 / Q000037:antagonists & inhibitors* / Q000276:immunology; D016896:Treatment Outcome
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D019947:Receptors, Interleukin-6; C502936:tocilizumab
keywords: IL-6; rheumatoid; subcutaneous; tocilizumab; trial