Successful Use of Interleukin 6 Antagonist Tocilizumab in a Patient With Refractory Cutaneous Lupus and Urticarial Vasculitis
Successful Use of Interleukin 6 Antagonist Tocilizumab in a Patient With Refractory Cutaneous Lupus and Urticarial Vasculitis
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DOI：
10.1097/rhu.0b013e31823ecd73
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发表时间：
2012-03-01
影响因子：
3.4
通讯作者：
Michet, Clement J.
中科院分区：
文献类型：
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作者：
Makol, Ashima;Gibson, Lawrence E.;Michet, Clement J.
托珠单抗（Actemra; Genentech，Inc）是第一种靶向细胞因子白细胞介素6（IL-6）的生物疗法。它是一种针对IL-6受体α链的人源化单克隆免疫球蛋白G1抗体，可防止IL-6与膜结合和可溶性IL-6受体结合。美国食品药品监督管理局于2010年1月批准其用于其他已批准疗法难治性类风湿性关节炎，并于2011年4月批准其用于全身性幼年特发性关节炎。它已被用作许多自身免疫性疾病的标签外治疗，其中IL-6在发病机制中起主要作用。我们报告一例难治性系统性红斑狼疮患者，22岁，女性，反复高热，多发性关节炎，弥漫性皮疹伴荨麻疹性血管炎，肿胀性狼疮，外用皮质类固醇，光保护，抗疟药，甲氨蝶呤，阿那白滞素，吗替麦考酚酯，依那西普和静脉注射免疫球蛋白治疗无效。皮质类固醇逐渐减少至10 mg以下后症状复发。观察到患者IL-6水平升高，开始使用托珠单抗。她的反应良好，发烧、关节炎和皮肤症状缓解，并能够成功地逐渐减少皮质类固醇治疗。
Tocilizumab (Actemra; Genentech, Inc) is the first biologic therapy targeting the cytokine interleukin 6 (IL-6). It is a humanized monoclonal immunoglobulin G1 antibody against the alpha-chain of the IL-6 receptor that prevents the binding of IL-6 to membrane-bound and -soluble IL-6 receptor. It was approved by the US Food and Drug Administration in January 2010 for rheumatoid arthritis refractory to other approved therapies and in April 2011 for systemic juvenile idiopathic arthritis. It has been used as an off-label treatment in many autoimmune diseases, where IL-6 plays a major role in pathogenesis. We report a case of refractory systemic lupus erythematosus in a 22-year-old woman with recurrent high-grade fever, polyarthritis, diffuse rash with urticarial vasculitis, and tumid lupus who did not respond to topical corticosteroids, photoprotection, antimalarials, methotrexate, anakinra, mycophenolate mofetil, etanercept, and intravenous immunoglobulin therapy. Symptoms recurred after corticosteroid tapers below 10 mg. She was noted to have an elevated IL-6 level, and tocilizumab was started. She responded favorably with remission of fever, arthritis, and skin manifestations and was able to taper corticosteroid therapy successfully.