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.

CONCLUSION:

Interleukin-6 receptor blockade is a promising therapeutic option for NMO.

CLASSIFICATION OF EVIDENCE:

This study provides Class IV evidence that in patients with NMO, TCZ reduces relapse rate, neuropathic pain, and fatigue.

• Authors: Manabu Araki, Takako Matsuoka, Katsuichi Miyamoto, Susumu Kusunoki, Tomoko Okamoto, Miho Murata, Sachiko Miyake, Toshimasa Aranami, Takashi Yamamura
• Journal: Neurology (Neurology) Vol. 82 Issue 15 Pg. 1302-6 (Apr 15 2014) ISSN: 1526-632X [Electronic] United States
• PMID: 24634453 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Antibodies, Monoclonal, Humanized
• Receptors, Interleukin-6
• tocilizumab

Topics

• Adult
• Antibodies, Monoclonal, Humanized (adverse effects, therapeutic use)
• Fatigue (drug therapy)
• Female
• Humans
• Male
• Middle Aged
• Neuralgia (drug therapy)
• Neuromyelitis Optica (drug therapy)
• Pilot Projects
• Receptors, Interleukin-6 (antagonists & inhibitors)
• Secondary Prevention
• Treatment Outcome