Macrophage activation syndrome secondary to tocilizumab: Myth or reality?

作者：Deroux A^*; Andry F; Bouillet L

来源：Revue de Medecine Interne, 2016, 37(8): 564-566.

DOI：10.1016/j.revmed.2015.10.348

• Tocilizumab
• IL-6 blockade
• Macrophage activation syndrome
• Juvenile idiopathic arthritis
• Cytopenias

Introduction. - Some authors have reported macrophage activation syndrome (MAS) secondary to infusion of tocilizumab, a monoclonal antibody that blocks interleukin-6 (IL-6). The pathophysiology of MAS is however linked to uncontrolled activation of innate immunity, mediated in part by IL-6. We conducted a study for macrophage activation biomarkers in a cohort of patients treated with tocilizumab.
Results. - Twenty-seven patients were included prospectively in our center. Levels of neutrophils, platelets, CRP and fibrinogen were lower at the end of treatment than at initiation (P < 0.05); other biomarkers were stable. There was neither clinical sign of SAM nor hemophagocytosis in myelogram.
Conclusion. - Laboratory abnormalities are related to direct blockade of IL-6 by tocilizumab and decrease hepatic protein synthesis. Tocilizumab is not responsible for MAS and associations described are more likely to be related to the autoimmune underlying disease, rather than treatment.

• 出版日期2016-8