A Novel Application for a Rheumatologic Medication

Charles F. Haller, Matthew B. Carroll*, Christopher Smith, Yolanda Moulds-Love, William Pomeroy and Bryan C. Ramsey

A Novel Application for a Rheumatologic Medication

Enter tocilizumab (Actemra®). Tocilizumab is a novel humanized monoclonal
antibody approved by the US Food and Drug Administration in 2010 for
the treatment of rheumatoid arthritis and (later) juvenile idiopathic arthritis.

The drug is administered as either a monthly intravenous infusion
or as a weekly subcutaneous injection.
The dose of the monthly infusion can vary between
4 mg/kg and 8 mg/kg but the once a week
or every other week injection is 162 mg subcutaneously.

In patients with rheumatoid arthritis, interleukin 6 (IL-6) is overproduced in the body,
causing fatigue, anemia, inflammation and
damage to bones, cartilage and tissue.

Acting as an antagonist of IL-6 receptors, tocilizumab interferes
with the pro-inflammatory effects of the IL-6–IL-6 receptor interaction.

Acute Myocardial Infarction occurs when myocardial ischemia,
a diminished blood supply to the heart muscle, exceeds a critical threshold
and overwhelms myocardial cellular repair mechanisms designed to maintain normal function.

Ischemia at this critical threshold level for an extended period results in irreversible myocardial
cell damage or death.

The elevation in serum IL-6 levels has demonstrated worse outcomes in the setting of
acute MI. In one study, elevated IL-6 levels were independent predictors of adverse events.

In another, univariate analysis, IL-6 was related to mortality.
IL-6 elevations also correlated with impaired left ventricular systolic and diastolic
dysfunction following acute MI up to 6 months.

Hence the genesis of “Short Term Administration of Tocilizumab following
Myocardial Infarction”, or STAT-MI. An extension of this trial,
the STAT-MI-extended, looks at 90 and 180 day MACE.

Osteol Rheumatol Open J. 2016; 1(1): e1-e2. doi: 10.17140/ORHOJ-1-e001