Exciting results with Tocilizumab for RA

[richie]

There have been very good results in clinical trials using RoActemra –generic name Tocilizumab for the treatment of RA –Compared to Humira or other antiTNF’s it was shown the results are four times better —-results for this drug was so promising that there are now studies going on in many countries all over the world using this drug to treat scleroderma —
richie

[Suzanne]

Do you have some links? I’ve only seen studies that show it works it better than other drugs for systemic JRA, and parents are posting it has helped their children.

Mom of teen daughter with Poly JIA since age 2. Current med: azithromycin 250 mg MWF.

[Anonymous]

Interesting Richie.

Is there any info on whether it supresses the immune system as much as Humira does or even more, making RA patients more vulnerable to infections?

[Maz]

@aoshi_xken wrote:

Interesting Richie.

Is there any info on whether it supresses the immune system as much as Humira does or even more, making RA patients more vulnerable to infections?

Hi Aoshi,

I don’t want to side-track any further info that Richie may have to share with you, however, I did some checking around and seems that Tocilizumab works by blocking IL-6. Here is info on Wiki about this particular inflammatory pathway:

http://en.wikipedia.org/wiki/Interleukin_6

Interestingly, the Chinese herb, artemisinin, works in a similar way:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3325975/

Here’s an FDA press release on Tocilizumab from 2010. In answer to your specific question about about vulnerability to infections:

http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm197108.htm

“Actemra works by blocking the action of interleukin-6, an immune system protein that is overabundant in people with rheumatoid arthritis.

The effectiveness and safety of Actemra was determined in five clinical trials in adult patients with active rheumatoid arthritis. In all of the trials, patients treated with Actemra experienced greater improvement in their tender or swollen joints than patients treated with a placebo.

The most common adverse reactions in clinical trials were upper respiratory tract infections, headache, inflammation of the nose or nasal passage, high blood pressure and increased liver enzymes. Elevations in the LDL or bad cholesterol were also seen in some patients, some of whom required the addition of lipid lowering agents.

Patients treated with Actemra are at increased risk for developing serious infections. Most patients who developed these infections in clinical trials were also taking other drugs that suppress the immune system such as methotrexate or corticosteroids.”

This is a fairly new drug in the grand scheme of things and it can take several years for reported side-effects to be published and for any black box warnings to be added. One of the concerning reported side-effects of the older biologics is the increased risks of certain cancers. It is kind of interesting that some cancers are associated with higher levels of IL-6 and there is some interest that this drug may actually be beneficial in this light (see Wiki link above for this excerpt):

“Advanced/metastatic cancer patients have higher levels of IL-6 in their blood.[24] Hence there is an interest in developing anti-IL-6 agents as therapy against many of these diseases.[25][26]”

As mentioned above, artemisinin that has been shown to have some immune-modulating effects on collagen-induced arthritis:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2275452/

Artemisinin has also been found to be incredibly powerful in treating certain cancers, like breast cancer (certain breast cancers are driven by estrogen). What concerns me about Tocilizumab, on the other hand, is that if estrogen is an inhibitor or IL-6 and a person is on this drug, would it make them more susceptible to other cancers (especially women on estrogen replacement therapy), such as breast cancer that may be driven by estrogen? It would be a kind of double-whammy in this type of situation. Just speculation on my part as I scanned these links quickly…

“Inhibitors of IL-6 (including estrogen) are used to treat postmenopausal osteoporosis.”

Here are some studies on artemisinin and breast cancer:

http://www.ncbi.nlm.nih.gov/pubmed/?term=artemisinin+breast+cancer

My best lay guess is that while artemisin and Tocilizumab work similarly by interfering with IL-6, they must do so by different pathways in the case of cancers, like breast cancer. I guess we’re just not going to know until long-term reports are published on this newer biologic.

Just mentioning this in the spirit of info-sharing as these would just be things I’d be checking if considering such a drug in my own case. It may not be something another person might consider or be concerned about…but I do have a family history of breast cancer. These diseases are hard and making decisions to try any drug – AP or otherwise – should always be an informed one. 🙂

[richie]

Hi–Really dont know –theres plenty of info on the net about it –Personally after what minocin has done for me –that should be everyones first choice —I am an advocate of Bill Clintons motto –its called KISS —meaning keep it simple –I found my doctor cause he got 6 out of 11 people better from scleroderma at a time when hardly anyone was getting better !!! –I figured hes my best shot !!!!
richie

[Anonymous]

@Maz wrote:

One of the concerning reported side-effects of the older biologics is the increased risks of certain cancers. It is kind of interesting that some cancers are associated with higher levels of IL-6 and there is some interest that this drug may actually be beneficial in this light (see Wiki link above for this excerpt):

“Advanced/metastatic cancer patients have higher levels of IL-6 in their blood.[24] Hence there is an interest in developing anti-IL-6 agents as therapy against many of these diseases.[25][26]”

That fact alone (being somehow beneficial – or at least neutral – for cancer) is actually interesting for those currently taking Humira or Enbrel!!

Being prone to infections is still a nasty side effect though, that’s why I was wondering if there were any claims about that new drug being “friendlier” than other biologics. I’ll look into it and let you guys know, even though it’ll be hard to get that info.

[richie]

On the Actemra .com the warnings are about the same as Humira and other biologics –however what caught my eye was that its also indicated for JRA and children starting at age two —-AS a matter of fact some of the studies were conducted comparing Humira to this drug –Four times more effective was the Acetemra
richie

[Suzanne]

@richie wrote:

On the Actemra .com the warnings are about the same as Humira and other biologics –however what caught my eye was that its also indicated for JRA and children starting at age two —-AS a matter of fact some of the studies were conducted comparing Humira to this drug –Four times more effective was the Acetemra
richie

It is indicated for systemic JRA, not pauciarticular or polyarticular. Systemic JRA presents with daily spiking fevers, rash, and joint pain and affects organs more than other types of JRA. Often they don’t have joint damage. They respond to pred, but usually not to TNFs.

Pauciarticular (usually one knee) often responds to just NSAIDs and joint injections.

Polyarticular is most comparable to adult RA, and those kids go up the familiar ladder – NSAIDs to mtx to TNFs, then they start looking other options like Actemra.

Mom of teen daughter with Poly JIA since age 2. Current med: azithromycin 250 mg MWF.

[Author]

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