Tocilizumab
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Anti-drug antibody production against tocilizumab: case report A 43-year-old man exhibited production of anti-drug antibody during treatment with tocilizumab for idiopathic multicentric Castleman disease (iMCD) with autoimmune hemolytic anemia (AIHA). The man, who was admitted due to shortness of breath and general fatigue, was diagnosed with iMCD with AIHA following detailed investigations. Treatment was initiated with tocilizumab 8 mg/kg every 2 weeks [route not stated]. A few days following the first dose of tocilizumab, his pyrexia and serum CRP levels improved. Six days after the first administration of tocilizumab, prednisolone was added to the treatment. However, following the second dose of tocilizumab, his condition worsened with increase in serum CRP levels and decrease in haemoglobin. Consequently, the interval of tocilizumab administration was shortened to 8 mg/kg every week but, he showed poor response. Blood tests exhibited production of anti-drug antibody (ADA) against tocilizumab with anti-body levels of 7.60 ng/mL and low serum tocilizumab level of 11.3 µg/mL. An enzyme-linked immunosorbent assay was performed to measure ADA against tocilizumab. Low serum IL-6 level of 47.7 pg/mL was observed. The low serum tocilizumab levels, low serum IL-6 levels and detected ADA were indicative of neutralising effect of ADA on tocilizumab. The man’s treatment with tocilizumab was stopped after six doses. Rituximab was started for iMCD, following which an improvement in anaemia and CRP levels was observed [outcome not stated]. Author comment: "A blood test revealed that anti-drug antibody (ADA) against tocilizumab had been produced". "In conclusion, we encountered a rare case of iMCD accompanied by AIHA in which the effect of tocilizumab might have been reduced, at least in part, because of ADA production." Tabata S, et al. Idiopathic Multicentric Castleman Disease with Autoimmune Hemolytic Anemia and Production of Anti-drug Antibody against Tocilizumab. Internal Medicine 58: 3313-3318, No. 22, 2019. Available from: URL: http:// 803439764 doi.org/10.2169/internalmedicine.2989-19 - Japan
0114-9954/19/1783-0001/$14.95 Adis © 2019 Springer Nature Switzerland AG. All rights reserved
Reactions 14 Dec 2019 No. 1783
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