Tocilizumab
- TRADE NAMES: Actemra (Roche); Atlizumab; RoActemra (Roche)
- INDICATIONS: Rheumatoid arthritis, juvenile idiopathic arthritis, Castleman’s disease
- CLASS: Anti-interleukin-6 receptor monoclonal antibody, Biologic, Biologic disease-modifying antirheumatic drug (bDMARD), Covid-19 putative drug, Disease-modifying antirheumatic drug (DMARD), Monoclonal antibody
- HALF-LIFE: 8–14 days
Efavirenz, Fesoterodine, Fingolimod, Infliximab, Lurasidone, Paricalcitol, Pazopanib, Typhoid Vaccine, Yellow Fever Vaccine
PREGNANCY CATEGORY: N/A
Based on animal data, may cause fetal harm
See adverse reactions attributed to class:
Anti-interleukin-6 receptor monoclonal antibody
See full prescribing information for complete boxed warning.
Acute generalized exanthematous pustulosis (AGEP)
(2012): Izquierdo JH+, Case Rep Rheumatol Dec, Epub
Anaphylactoid reactions / anaphylaxis (includes anaphylactic shock)
(2017): Machado SH+, Expert Opin Drug Saf 16(4), 493 [REVIEW]
(2016): Farah Z+, Biologics 10, 59
(2011): Koike T+, Ann Rheum Dis 70(12), 2148
(2010): Tanaka T+, Expert Rev Clin Immunol 6(6), 843
(2008): Yokota S+, Lancet 371(9617), 998
Cellulitis
(2017): Ishiguro N+, Mod Rheumatol 27(2), 2171%
(2017): Lin CT+, J Microbiol Immunol Infect Jul, Epub ahead of print
(2017): Machado SH+, Expert Opin Drug Saf 16(4), 493 [REVIEW]
(2015): Brunner HI+, Ann Rheum Dis 74(6), 11101%
(2014): Nakashima Y+, Drug Des Devel Ther 8, 913
(2013): Weinblatt ME+, Arthritis Care Res (Hoboken) 65(3), 3621%
(2012): Yazici Y+, Ann Rheum Dis 71(2), 198 (2 cases)
(2011): Koike T+, Ann Rheum Dis 70(12), 2148
(2008): Genovese MC+, Arthritis Rheum 58(10), 29681%
Herpes zoster
(2017): Ishiguro N+, Mod Rheumatol 27(2), 2171%
(2017): Machado SH+, Expert Opin Drug Saf 16(4), 493 [REVIEW]
(2016): Farah Z+, Biologics 10, 59
(2015): Horneff G, Expert Opin Drug Saf 14(7), 1111 [REVIEW]
(2011): Koike T+, Ann Rheum Dis 70(12), 2148
(2011): Roux C+, J Rheumatol 38(2), 399 (ophthalmic)
(2009): Nishimoto N+, Ann Rheum Dis 68(10), 1580
(2008): Genovese MC+, Arthritis Rheum 58(10), 2968<1%
Hypersensitivity
(2018): Garcia-Neuer M+, J Allergy Clin Immunol Pract 6(1), 90 (vocal fold motion)
(2017): Jones G+, J Rheumatol 44(2), 142
(2015): Galvao VR+, J Allergy Clin Immunol Pract 3(2), 175 [REVIEW]
(2011): Bannwarth B+, Expert Opin Drug Saf 10(1), 123 [REVIEW]
(2011): Koike T+, Ann Rheum Dis 70(12), 2148
(2010): Tanaka T+, Expert Rev Clin Immunol 6(6), 843
Psoriasis
(2018): Hayakawa M+, Rheumatol Int Oct, Epub ahead of print [REVIEW] (1 case)
(2018): Sehgal R+, Clin Med Res Apr, Epub ahead of print
(2012): Wendling D+, J Rheumatol 39(3), 657
(2010): Laurent S+, Br J Dermatol 163(6), 1364
Rash 2%
(2019): Bouajina E+, Clin Rheumatol Dec, Epub ahead of print (14 cases)
(2017): Lai JM+, Zhonghua Er Ke Za Zhi (Chinese) 55(11), 830
(2016): Teitsma XM+, Arthritis Res Ther 18(1), 211 [REVIEW]
(2015): Brunner HI+, Ann Rheum Dis 74(6), 11102%
(2015): McLaughlin M+, Expert Opin Drug Saf 14(3), 429 [REVIEW]
(2011): Campbell L+, Rheumatology (Oxford) 50(3), 552 [REVIEW]
(2008): Emery P+, Ann Rheum Dis 67(11), 1516
(2008): Plushner SL, Ann Pharmacother 42(11), 1660 [REVIEW]
Sarcoidosis / sarcoid-like reaction (cutaneous sarcoidosis)
(2017): Perez-De-Lis M+, Expert Opin Drug Saf 16(11), 1255 [REVIEW]
Urticaria / hives
(2017): Machado SH+, Expert Opin Drug Saf 16(4), 493 [REVIEW]
(2015): McLaughlin M+, Expert Opin Drug Saf 14(3), 429 [REVIEW]
Vasculitis (angiitis) / cutaneous vasculitis (angiitis)
(2017): Perez-De-Lis M+, Expert Opin Drug Saf 16(11), 1255 [REVIEW]
Aphthous stomatitis / aphthous ulcer / aphtha (aphthae)
(2013): Samimi M+, Ann Dermatol Venereol (French) 140(2), 120 (2 cases)
Mucosal ulceration
(2016): Emmi G+, Semin Arthritis Rheum 46(1), e1 (exacerbation)
(2016): Vitiello G+, Semin Arthritis Rheum 46(2), e9
Oral ulceration (see also aphthous stomatitis / aphthous ulcer / aphtha) 2%
(2017): Machado SH+, Expert Opin Drug Saf 16(4), 493 [REVIEW]
Cardiotoxicity
(2017): Ishiguro N+, Mod Rheumatol 27(2), 217<1%
(2015): McLaughlin M+, Expert Opin Drug Saf 14(3), 429 [REVIEW]
(2011): Koike T+, Ann Rheum Dis 70(12), 2148
Hypertension 6%
(2019): Elmedany SH+, Clin Rheumatol March, Epub ahead of print
(2016): Flaig T+, J Clin Pharm Ther 41(6), 718 [REVIEW] (passim)
(2016): Song ST+, Clin Exp Rheumatol 34(6 Suppl 102), S64
(2010): Tanaka T+, Expert Rev Clin Immunol 6(6), 843
Headache 7%
(2017): Machado SH+, Expert Opin Drug Saf 16(4), 493 [REVIEW]
(2015): Brunner HI+, Ann Rheum Dis 74(6), 11108%
(2015): McLaughlin M+, Expert Opin Drug Saf 14(3), 429 [REVIEW]
(2011): van Duin D+, Emerg Infect Dis 17(4), 754
(2010): Tanaka T+, Expert Rev Clin Immunol 6(6), 843
(2008): Emery P+, Ann Rheum Dis 67(11), 1516
(2008): Plushner SL, Ann Pharmacother 42(11), 1660 [REVIEW]
Leukoencephalopathy / posterior reversible encephalopathy syndrome (PRES))
(2009): Kobayashi K+, Intern Med 48(15), 1307
Neurotoxicity
(2011): Koike T+, Ann Rheum Dis 70(12), 2148
(2009): Nishimoto N+, Ann Rheum Dis 68(10), 1580
Alanine aminotransferase (ALT) increased 6%
(2017): Canete JD+, Expert Opin Biol Ther Jun, Epub ahead of print [REVIEW]
(2017): Genovese MC+, Arthritis Rheumatol 69(9), 17518%
(2017): Machado SH+, Expert Opin Drug Saf 16(4), 493 [REVIEW]
(2016): Kivitz A+, Rheumatol Ther 3(2), 29138%
(2015): Hammoudeh M+, Int J Rheumatol May, Epub1%
(2015): McLaughlin M+, Expert Opin Drug Saf 14(3), 429 [REVIEW]
(2014): Nakashima Y+, Drug Des Devel Ther 8, 913
(2014): Stoll ML+, Pediatr Rheumatol Online J 12, 13
(2013): Dougados M+, Ann Rheum Dis 72(1), 431%
(2008): Genovese MC+, Arthritis Rheum 58(10), 29684%
Aspartate aminotransferase (AST) increased
(2017): Canete JD+, Expert Opin Biol Ther 17(9), 1089 [REVIEW]
(2017): Genovese MC+, Arthritis Rheumatol 69(9), 17514%
(2017): Machado SH+, Expert Opin Drug Saf 16(4), 493 [REVIEW]
(2014): Nakashima Y+, Drug Des Devel Ther 8, 913
Hypercholesterolemia
(2021): de Boysson H+, Arthritis Res Ther 23(1), 143 (4 cases)
(with reduced glucocorticoid therapy)
(2019): Bouajina E+, Clin Rheumatol Dec, Epub ahead of print (18 cases)
(2019): Elmedany SH+, Clin Rheumatol March, Epub ahead of print
(2017): Caporali R+, Clin Exp Rheumatol 35(6), 919
(2017): Machado SH+, Expert Opin Drug Saf 16(4), 493 [REVIEW]
(2016): Flaig T+, J Clin Pharm Ther 41(6), 718 [REVIEW] (passim)
(2015): Hammoudeh M+, Int J Rheumatol May, Epub3%
Hyperlipidemia
(2019): Elmedany SH+, Clin Rheumatol March, Epub ahead of print
(2012): Psenak O+, Z Rheumatol 71(5), 420
(2010): Febbraio MA+, Clin Pharmacol Ther 87 (4), 396
(2010): Jones G, Expert Rev Clin Immunol 6 (2), 189
(2008): Genovese MC+, Arthritis Rheum 58(10), 296823%
(2008): Plushner SL, Ann Pharmacother 42(11), 1660 [REVIEW]
Hypertransaminasemia (transaminitis) / elevated transaminases
(2021): de Boysson H+, Arthritis Res Ther 23(1), 143 (1 case) (with reduced glucocorticoid therapy)
(2020): Langevitz P+, Isr Med Assoc J 9(22), 491-49711%
(2020): Langevitz P+, Isr Med Assoc J 22(9), 557-56311%
(2019): Bouajina E+, Clin Rheumatol Dec, Epub ahead of print (15 cases)
(2019): Elmedany SH+, Clin Rheumatol March, Epub ahead of print
Hypertriglyceridemia (includes triglycerides increased)
(2019): Bouajina E+, Clin Rheumatol Dec, Epub ahead of print (17 cases)
(2016): Flaig T+, J Clin Pharm Ther 41(6), 718 [REVIEW] (passim)
(2015): Hammoudeh M+, Int J Rheumatol May, Epub1%
Diarrhea
(2017): Machado SH+, Expert Opin Drug Saf 16(4), 493 [REVIEW]
(2015): Brunner HI+, Ann Rheum Dis 74(6), 11104%
Gastroenteritis
(2017): Canete JD+, Expert Opin Biol Ther 17(9), 1089 [REVIEW]
(2017): Machado SH+, Expert Opin Drug Saf 16(4), 493 [REVIEW]
(2016): Yokota S+, Ann Rheum Dis 75(9), 16547%
(2014): Nakashima Y+, Drug Des Devel Ther 8, 913
(2011): Koike T+, Ann Rheum Dis 70(12), 2148
(2008): Yokota S+, Lancet 371(9617), 998
Gastrointestinal bleeding
(2017): Machado SH+, Expert Opin Drug Saf 16(4), 493 [REVIEW]
(2014): Stoll ML+, Pediatr Rheumatol Online J 12, 13
(2008): Yokota S+, Lancet 371(9617), 998
Gastrointestinal disorder / discomfort
(2019): Bouajina E+, Clin Rheumatol Dec, Epub ahead of print (3 cases)
Gastrointestinal perforation / gastric perforation
(2019): Giles JT+, Arthritis Rheumatol Aug, Epub ahead of print
(2017): Canete JD+, Expert Opin Biol Ther 17(9), 1089 [REVIEW]
(2017): Ishiguro N+, Mod Rheumatol 27(2), 217<1%
(2015): McLaughlin M+, Expert Opin Drug Saf 14(3), 429 [REVIEW]
(2012): Ruderman EM, Rheumatology (Oxford) 51, 37
(2011): Bannwarth B+, Expert Opin Drug Saf 10(1), 123 [REVIEW]
(2011): Gout T+, Clin Rheumatol 30(11), 1471 [REVIEW]
(2011): Koike T+, Ann Rheum Dis 70(12), 2148
(2010): Tanaka T+, Expert Rev Clin Immunol 6(6), 843
Hepatic sarcoidosis (see also sarcoidosis / sarcoid-like reaction (cutaneous sarcoidosis))
(2021): Lambert N+, Br J Clin Pharmacol Apr, Online ahead of print (1 case / female)
Hepatotoxicity / liver injury / acute liver injury / drug-induced liver injury (DILI)
(2021): Jiménez-Lozano I+, J Clin Pharm Ther Feb, Online ahead of print (2 cases) (with concomitant medication)
(2018): Shirai T+, Medicine (Baltimore) 97(23) [REVIEW]
(2017): Anger F+, Rheumatology (Oxford) 56(9), 1628
(2017): Genovese MC+, Arthritis Rheumatol 69(9), 1751 (severe / 7 cases)
(2017): Ishiguro N+, Mod Rheumatol 27(2), 2177%
(2017): Machado SH+, Expert Opin Drug Saf 16(4), 493 [REVIEW]
(2016): Yokota S+, Ann Rheum Dis 75(9), 16547%
(2015): Hammoudeh M+, Int J Rheumatol May, Epub10%
(2015): Wang G+, Int J Gen Med 8, 187
(2014): Machado-Alba JE+, Rev Panam Salud Publica 36(6), 39610%
(2014): Navarro G+, Semin Arthritis Rheum 43(4), 458
(2014): Stoll ML+, Pediatr Rheumatol Online J 12, 13
(2011): Hagiwara K, Endoscopy 43(10), 928
(2011): Iwasa T+, Endoscopy 43(1), 70
(2010): Storage SS+, Korean J Intern Med 25 (1), 1
(2009): Nishimoto N+, Ann Rheum Dis 68(10), 1580
(2008): Plushner SL, Ann Pharmacother 42(11), 1660 [REVIEW]
Nausea
(2018): Emery P+, Rheumatology (Oxford) Dec, Epub ahead of print7%
(2016): Teitsma XM+, Arthritis Res Ther 18(1), 211 [REVIEW]
(2015): Brunner HI+, Ann Rheum Dis 74(6), 11106%
(2011): Campbell L+, Rheumatology (Oxford) 50(3), 552 [REVIEW]
Pancreatitis / acute pancreatitis
(2017): Perez-De-Lis M+, Expert Opin Drug Saf 16(11), 1255 [REVIEW]
(2016): Flaig T+, J Clin Pharm Ther 41(6), 718 [REVIEW]
Urinary tract infection
(2017): Canete JD+, Expert Opin Biol Ther 17(9), 1089 [REVIEW]
(2017): Ishiguro N+, Mod Rheumatol 27(2), 217<1%
(2010): Illei GG+, Arthritis Rheum 62(2), 542
Hemotoxicity
(2017): Martis N+, Joint Bone Spine 84(3), 369 (hypofibrinogenemia)
(2012): Matsuoka M+, Int J Hematol 96(6), 781
Leukocytopenia (leukopenia) <2%
(2020): Langevitz P+, Isr Med Assoc J 9(22), 491-49711%
(2020): Langevitz P+, Isr Med Assoc J 22(9), 557-56311%
(2017): Caporali R+, Clin Exp Rheumatol 35(6), 919
(2017): Kaneshiro S+, Mod Rheumatol 27(1), 42 (1 case) (with tacrolimus)
(2016): Devauchelle-Pensec V+, Ann Rheum Dis 75(8), 1506
(2014): Machado-Alba JE+, Rev Panam Salud Publica 36(6), 39612%
(2011): Koike T+, Ann Rheum Dis 70(12), 2148
Lymphopenia (lymphocytopenia) / lymphocytes decreased
(2017): Kaneshiro S+, Mod Rheumatol 27(1), 42 (3 cases) (with tacrolimus)
(2014): Stoll ML+, Pediatr Rheumatol Online J 12, 13
Neutropenia (neutrophils decreased)
(2020): Langevitz P+, Isr Med Assoc J 22(9), 557-56312%
(2019): Bouajina E+, Clin Rheumatol Dec, Epub ahead of print (7 cases)
(2019): Elmedany SH+, Clin Rheumatol March, Epub ahead of print
(2018): Opoka-Winiarska V+, Clin Rheumatol Apr, Epub ahead of print
(2017): Canete JD+, Expert Opin Biol Ther 17(9), 1089 [REVIEW]
(2017): Espinoza F+, J Rheumatol 44(6), 84419%
(2017): Machado SH+, Expert Opin Drug Saf 16 (4), 493 [REVIEW]
(2017): Perez-De-Lis M+, Expert Opin Drug Saf 16(11), 1255 [REVIEW]
(2016): Albattal BM, Ann Saudi Med 36(3), 190
(2016): Devauchelle-Pensec V+, Ann Rheum Dis 75(8), 1506 (transient)
(2016): Farah Z+, Biologics 10, 59
(2016): Kivitz A+, Rheumatol Ther 3(2), 2913% (grade 3 or 4) (transient)
(2015): Horneff G, Expert Opin Drug Saf 14(7), 1111 [REVIEW]
(2015): McLaughlin M+, Expert Opin Drug Saf 14(3), 429 [REVIEW]
(2014): Loricera J+, Clin Exp Rheumatol 32(3 Suppl 82), s79 [REVIEW]
(2014): Stoll ML+, Pediatr Rheumatol Online J 12, 13
(2013): Uda H+, Scand J Rheumatol 42(3), 247 (60 cases)
(2012): De Benedetti F+, N Engl J Med 367(25), 2385
(2011): Bannwarth B+, Expert Opin Drug Saf 10(1), 123 [REVIEW]
(2011): Koike T+, Ann Rheum Dis 70(12), 2148
(2010): Storage SS+, Korean J Intern Med 25 (1), 1
(2008): Genovese MC+, Arthritis Rheum 58(10), 29684% (grade 3)
(2008): Plushner SL, Ann Pharmacother 42(11), 1660 [REVIEW]
Infusion-related reactions
(2015): Horneff G, Expert Opin Drug Saf 14(7), 1111 [REVIEW]
(2015): McLaughlin M+, Expert Opin Drug Saf 14(3), 429 [REVIEW]
(2014): Yokota S+, J Rheumatol 41(4), 759
Infusion-site reactions
(2015): McLaughlin M+, Expert Opin Drug Saf 14(3), 429 [REVIEW]
(2009): Prescrire Int 18 (103), 198
Arthralgia
(2015): McLaughlin M+, Expert Opin Drug Saf 14(3), 429 [REVIEW]
(2014): Nakashima Y+, Drug Des Devel Ther 8, 913
(2013): Uda H+, Scand J Rheumatol 42(3), 247
(2011): Koike T+, Ann Rheum Dis 70(12), 2148
Fractures
(2011): Koike T+, Ann Rheum Dis 70(12), 2148
(2009): Nishimoto N+, Ann Rheum Dis 68 (10), 1580
Uveitis / anterior uveitis / posterior uveitis / panuveitis
(2015): Horneff G, Expert Opin Drug Saf 14(7), 1111 [REVIEW]
Glomerulonephritis (includes membranous nephropathy)
(2013): Matsuo Y+, Rheumatology (Oxford) 52(7), 1341
Nephrotoxicity / kidney injury / acute kidney injury (AKI) / drug-induced kidney injury
(2007): Matsuyama M+, Intern Med 46(11), 771
Pyelonephritis
(2011): Koike T+, Ann Rheum Dis 70(12), 2148
(2010): Illei GG+, Arthritis Rheum 62(2), 542
(2009): Nishimoto N+, Ann Rheum Dis 68(10), 1580
Bronchitis 3%
(2017): Machado SH+, Expert Opin Drug Saf 16(4), 493 [REVIEW]
(2016): Yokota S+, Ann Rheum Dis 75(9), 16546%
(2015): Brunner HI+, Ann Rheum Dis 74(6), 11101%
(2011): Koike T+, Ann Rheum Dis 70(12), 2148
(2009): Nishimoto N+, Ann Rheum Dis 68(10), 1580
(2008): Yokota S+, Lancet 371(9617), 998
Influenza
(2016): Yokota S+, Ann Rheum Dis 75(9), 16547%
(2015): Hammoudeh M+, Int J Rheumatol May, Epub1%
(2013): Wendling D+, Joint Bone Spine 80(2), 225
Nasopharyngitis 7%
(2017): Machado SH+, Expert Opin Drug Saf 16(4), 493 [REVIEW]
(2016): Yokota S+, Ann Rheum Dis 75(9), 16545%
(2015): Brunner HI+, Ann Rheum Dis 74(6), 111012%
(2011): Campbell L+, Rheumatology (Oxford) 50(3), 552 [REVIEW]
(2011): van Duin D+, Emerg Infect Dis 17(4), 754
(2010): Tanaka T+, Expert Rev Clin Immunol 6(6), 843
(2008): Plushner SL, Ann Pharmacother 42(11), 1660 [REVIEW]
Pharyngitis
(2018): Opoka-Winiarska V+, Clin Rheumatol Apr, Epub ahead of print
(2017): Machado SH+, Expert Opin Drug Saf 16(4), 493 [REVIEW]
(2016): Yokota S+, Ann Rheum Dis 75(9), 16545%
(2015): Brunner HI+, Ann Rheum Dis 74(6), 11104%
Pneumonia
(2020): Gouveia PA+, Cureus 12(2), e6982 (1 case)
(2017): Canete JD+, Expert Opin Biol Ther 17(9), 1089 [REVIEW]
(2017): Ishiguro N+, Mod Rheumatol 27(2), 2171%
(2017): Jones G+, J Rheumatol 44(2), 142
(2017): Lin CT+, J Microbiol Immunol Infect Jul, Epub ahead of print
(2017): Machado SH+, Expert Opin Drug Saf 16(4), 493 [REVIEW]
(2015): Brunner HI+, Ann Rheum Dis 74(6), 11102%
(2014): Nakashima Y+, Drug Des Devel Ther 8, 913
(2013): Weinblatt ME+, Arthritis Care Res (Hoboken) 65(3), 3621%
(2011): Ikegawa K+, Intern Med 50(19), 2191 (with methotrexate)
(2011): Koike T+, Ann Rheum Dis 70(12), 2148
(2009): Nishimoto N+, Ann Rheum Dis 68(10), 1580
(2008): Genovese MC+, Arthritis Rheum 58(10), 2968<1%
Pneumothorax
(2011): Koike T+, Ann Rheum Dis 70(12), 2148
(2009): Nishimoto N+, Ann Rheum Dis 68(10), 1580
Pulmonary sarcoidosis (see also sarcoidosis / sarcoid-like reaction (cutaneous sarcoidosis))
(2021): Lambert N+, Br J Clin Pharmacol Apr, Online ahead of print (1 case / female)
Pulmonary toxicity
(2017): Chen J+, Expert Opin Biol Ther 17(3), 265
(2017): Ishiguro N+, Mod Rheumatol 27(2), 2171%
(2014): Roubille C+, Semin Arthritis Rheum 43(5), 613 [REVIEW]
(2012): Kawashiri SY+, Rheumatol Int 32(12), 4023 (fatal)
(exacerbation)
(2011): Honda H+, Mod Rheumatol 21(6), 660 (with etanercept)
Upper respiratory tract infection 7%
(2018): Emery P+, Rheumatology (Oxford) Dec, Epub ahead of print7%
(2018): Opoka-Winiarska V+, Clin Rheumatol Apr, Epub ahead of print
(2017): Machado SH+, Expert Opin Drug Saf 16(4), 493 [REVIEW]
(2016): Flaig T+, J Clin Pharm Ther 41(6), 718 [REVIEW] (passim)
(2016): Yokota S+, Ann Rheum Dis 75(9), 165417%
(2015): Brunner HI+, Ann Rheum Dis 74(6), 11107%
(2015): Hammoudeh M+, Int J Rheumatol May, Epub3%
(2015): McLaughlin M+, Expert Opin Drug Saf 14(3), 429 [REVIEW]
(2011): Campbell L+, Rheumatology (Oxford) 50(3), 552 [REVIEW]
(2011): van Duin D+, Emerg Infect Dis 17(4), 754
(2010): Illei GG+, Arthritis Rheum 62(2), 542
(2010): Tanaka T+, Expert Rev Clin Immunol 6(6), 843
Adverse effects
(2021): Datta R+, Infect Control Hosp Epidemiol May, Online ahead of print29%
(2020): Zhang C+, Lancet Neurol 19(5), 39161%
(2019): Haraoui B+, Rheumatol Ther March, Epub ahead of print
(2019): Isaacs JD+, Rheumatol Adv Pract 3(1), eCollection6% (serious) (± combination therapy with conventional synthetic disease-modifying antirheumatic drugs (DMARDs))
(2018): Nakaoka Y+, Ann Rheum Dis 77(3), 348 (serious / 1 case)
(2017): Caporali R+, Clin Exp Rheumatol 35(6), 91929%
(2017): Notario Ferreira I+, Reumatol Clin 13(2), 78
(2016): Al-Mayouf SM+, Int J Rheum Dis 19(6), 600
(2016): Albattal BM, Ann Saudi Med 36(3), 19011%
(2016): Regent A+, J Rheumatol 43(8), 1547
(2016): Yokota S+, Ann Rheum Dis 75(9), 165469%
(2015): Tarkiainen M+, Rheumatology (Oxford) 54(7), 1170
(2014): Machado-Alba JE+, Rev Panam Salud Publica 36(6), 396
(2013): Gabay C+, Lancet 381(9877), 154112%
(2012): Imagawa T+, Mod Rheumatol 22(1), 109
(2008): Genovese MC+, Arthritis Rheum 58(10), 29687%
Cytomegalovirus infection
(2021): Jiménez-Lozano I+, J Clin Pharm Ther Feb, Online ahead of print (1 case ) (reactivation; with concomitant medication)
Death
(2019): Isaacs JD+, Rheumatol Adv Pract 3(1), eCollection (1 case) (± combination therapy with conventional synthetic disease-modifying antirheumatic drugs (DMARDs))
(2018): Ogata A+, Mod Rheumatol 28(1), 76 (1 case)
(2017): Ishiguro N+, Mod Rheumatol 27(2), 2171%
(2016): Khanna D+, Lancet 387(10038), 2630 (1 case)
(2015): McLaughlin M+, Expert Opin Drug Saf 14(3), 429 [REVIEW]
(2012): Kawashiri SY+, Rheumatol Int 32(12), 4023
Infection
(2021): de Boysson H+, Arthritis Res Ther 23(1), 143 (3 cases) (with reduced glucocorticoid therapy)
(2021): Wu S+, Joint Bone Spine Apr, Online ahead of print38% (severe / 4 cases)
(2019): Giles JT+, Arthritis Rheumatol Aug, Epub ahead of print
(2018): Iannone F+, Clin Rheumatol 37(2), 315
(2018): Ogata A+, Mod Rheumatol 28(1), 76
(2017): Ishiguro N+, Mod Rheumatol 27(2), 21712%
(2017): Jones G+, J Rheumatol 44(2), 142
(2017): Machado SH+, Expert Opin Drug Saf 16(4), 493 [REVIEW]
(2016): Khanna D+, Lancet 387(10038), 263016%
(2016): Kivitz A+, Rheumatol Ther 3(2), 2914% (serious)
(2016): Teitsma XM+, Arthritis Res Ther 18(1), 211 [REVIEW] (skin and respiratory)
(2016): Yokota S+, Ann Rheum Dis 75(9), 165441%
(2015): Brunner HI+, Ann Rheum Dis 74(6), 1110
(2015): Horneff G, Expert Opin Drug Saf 14(7), 1111 [REVIEW]
(2015): McLaughlin M+, Expert Opin Drug Saf 14(3), 429 [REVIEW]
(2015): Wang G+, Int J Gen Med 8, 187
(2014): Dhillon S, BioDrugs 28(1), 75 [REVIEW]
(2014): Nakashima Y+, Drug Des Devel Ther 8, 913
(2014): Navarro G+, Semin Arthritis Rheum 43(4), 458
(2014): Stoll ML+, Pediatr Rheumatol Online J 12, 13
(2014): Yokota S+, J Rheumatol 41(4), 759
(2013): Dougados M+, Ann Rheum Dis 72(1), 43
(2013): Milin M+, Joint Bone Spine 80(2), 221
(2013): Nguyen MT+, BMJ Case Rep 2013 (3 cases)
(2013): Weinblatt ME+, Arthritis Care Res (Hoboken) 65(3), 362
(2012): Bykerk VP+, Ann Rheum Dis 71(12), 1950
(2012): De Benedetti F+, N Engl J Med 367(25), 2385
(2012): Yazici Y+, Ann Rheum Dis 71(2), 198
(2011): Bannwarth B+, Expert Opin Drug Saf 10(1), 123 [REVIEW]
(2011): Burmester GR+, Ann Rheum Dis 70(5), 7553%
(2011): Inayama M+, Kansenshogaku Zasshi (Japanese) 85(5), 523
(2011): Koike T+, Ann Rheum Dis 70(12), 2148
(2010): Hirabayashi Y+, Rheumatol Int 30(8), 1041
(2010): Jones G, Expert Rev Clin Immunol 6 (2), 189
(2010): Nishimoto N+, Mod Rheumatol 20(3), 222
(2010): Tanaka T+, Expert Rev Clin Immunol 6(6), 843
(2008): Emery P+, Ann Rheum Dis 67(11), 1516
(2008): Genovese MC+, Arthritis Rheum 58(10), 29687%
(2008): Plushner SL, Ann Pharmacother 42(11), 1660 [REVIEW]
(2008): Smolen JS+, Lancet 371, 987
(2007): Nishimoto N+, Ann Rheum Dis 66(9), 1162
(2006): Ding C+, Rev Recent Clin Trials 1(3), 193 [REVIEW]
Malignancies
(2017): Ishiguro N+, Mod Rheumatol 27(2), 2171%
(2011): Koike T+, Ann Rheum Dis 70(12), 2148
Click on the DRUG REVIEW ARTICLE tab (above) to see a review of tocilizumab in the treatment of juvenile idiopathic arthritis in the Taylor & Francis journal Expert Opinion on Drug Safety. (Note that non-subscribers to the journal will only be able to see an abstract of the article.)
Adverse reactions attributed to entire drug class Anti-interleukin-6 receptor monoclonal antibody
Neutropenia (neutrophils decreased)
(2019): Andres E+, J Clin Med 8(9), E1351 [REVIEW]
Adverse reactions attributed to entire drug class Biologic
Psoriasis
(2020): Afach S+, Br J Dermatol May, Online ahead of print [REVIEW]
(2020): Montolio Chiva L+, Reumatol Clin Mar, Epub ahead of print [REVIEW]
Vasculitis (angiitis) / cutaneous vasculitis (angiitis)
(2016): Gutierrez-Gonzalez LA, Curr Rheumatol Rep 18(7), 39 [REVIEW]
Hepatotoxicity / liver injury / acute liver injury / drug-induced liver injury (DILI)
(2021): Jee A+, Int J Mol Sci 22(6), 2954 [REVIEW]
Infusion-related reactions
(2016): Al-Mayouf SM+, Int J Rheum Dis 19(6), 60034%
Uveitis / anterior uveitis / posterior uveitis / panuveitis
(2020): Klein A+, ACR Open Rheumatol 2(1), 376%
Adverse effects
(2020): Iannone LF+, PLoS One 15(11), eCollection
(2020): Roberti R+, Curr Med Res Opin Jun, Online ahead of print
(2016): Al-Mayouf SM+, Int J Rheum Dis 19(6), 60035%
Infection
(2020): Klein A+, ACR Open Rheumatol 2(1), 373%
Adverse reactions attributed to entire drug class Biologic disease-modifying antirheumatic drug (bDMARD)
Cutaneous adverse reaction / severe cutaneous adverse drug reaction (SCAR)
(2020): Barbieri MA+, J Clin Med 9(4), E122716%
Lymphocytosis / lymphocytes increased
(2020): Barbieri MA+, J Clin Med 9(4), E12279% (serious)
Neutropenia (neutrophils decreased)
(2020): Barbieri MA+, J Clin Med 9(4), E122713% (serious)
Musculoskeletal adverse effects
(2020): Barbieri MA+, J Clin Med 9(4), E122718%
Uveitis / anterior uveitis / posterior uveitis / panuveitis
(2020): Barbieri MA+, J Clin Med 9(4), E12277% (serious)
Adverse effects
(2020): Cometi L+, J Clin Med 9(5), E1310
(2020): Martínez-López-de-Castro N+, Eur J Rheumatol 7(2), 53-59
Infection
(2020): Barbieri MA+, J Clin Med 9(4), E122722%
Adverse reactions attributed to entire drug class Covid-19 putative drug
Cutaneous adverse reaction / severe cutaneous adverse drug reaction (SCAR)
(2020): Tursen U+, Dermatol Ther May, Epub ahead of print [REVIEW]
Cardiovascular adverse effect
(2020): Carpenter A+, Front Cardiovasc Med 7, 85 [REVIEW]
(2020): Giudicessi JR+, Mayo Clin Proc May, Online ahead of print [REVIEW]
(2020): Naksuk N+, Eur Heart J Acute Cardiovasc Care May, Epub ahead of print [REVIEW]
(2020): Sarayani A+, Res Social Adm Pharm Apr, Epub ahead of print [REVIEW]
(2020): Zhang D+, Zhongguo Zhong Yao Za Zhi (Chinese) 45(10), 2275-2286 [REVIEW]
Neuropsychiatric / neuropsychological adverse effect
(2021): Borah P+, Front Mol Biosci 8, 627723
(2020): García CAC+, Gen Hosp Psychiatry Jun, Online ahead of print [REVIEW]
Gastrointestinal disorder / discomfort
(2020): Sun J+, Clin Pharmacol Ther Apr, Epub ahead of print23%
Hepatic (liver) disorder / hepatobiliary disorder / hepatic (liver) dysfunction
(2020): Sun J+, Clin Pharmacol Ther Apr, Epub ahead of print14%
Thrombocytopenia
(2020): Nham E+, Infect Chemother Apr, Epub ahead of print
Adverse effects
(2021): Bérard A+, PLoS One 16(5), e0251746 [REVIEW] (in pregnancy)
(2021): Cheng Q+, Aging (Albany NY) Sep, Online ahead of print [REVIEW]
(2021): Cruciani F+, Recenti Prog Med 112(3), 195-206 [REVIEW]
(2021): Ommati MM+, J Biochem Mol Toxicol May, Online ahead of print [REVIEW]
(2021): Qiu R+, Medicine (Baltimore) 100(16), e25532 [REVIEW]
(2021): Wu SS+, Chin Med J (Engl) Jul, Online ahead of print [REVIEW]
(2020): Favilli A+, J Matern Fetal Neonatal Med Jun, Online ahead of print [REVIEW]
(2020): Griffiths G+, Trials 21(1), 544
(2020): Patil VM+, Life Sci May, Epub ahead of print [REVIEW]
(2020): Rhodes NJ+, medRxiv Jun, Preprint
(2020): Sun J+, Clin Pharmacol Ther Apr, Epub ahead of print38%
(2020): Svensson M, Lakartidningen (Swedish) Apr, 117
(2020): Wen CY+, Zhonghua Nei Ke Za Zhi (Chinese) May, Epub ahead of print
(2020): Zekarias A+, Drug Saf Sep, Online ahead of print [REVIEW]
(2020): Zhong H+, Pharmacol Res Apr, Epub ahead of print [REVIEW]
Page last updated 11/26/2021
Symbol key
Incidence 
- <1%
- 1-5%
- 5-10%
- 10-15%
- 15-20%
- 20-30%
- >30%
Seriousness
- Hospitalization possible
- Life threatening
- Fatal
Warnings in other populations
- Breast feeding
- Geriatric
- Pediatric
