Successful Use of Tocilizumab in a Patient with Coexisting Rheumatoid Arthritis and Ulcerative Colitis

Abstract EN

Tocilizumab is an interleukin-6 receptor inhibitor licensed for moderate to severe rheumatoid arthritis (RA).

We report a case of Tocilizumab monotherapy for severe active RA in a patient with coexisting ulcerative colitis (UC).

The patient was intolerant to multiple disease-modifying drugs, so Tocilizumab monotherapy was commenced.

We found clinical improvement in both RA and UC.

There was no major adverse event after 2 years.

Manufacturer advised caution in using Tocilizumab in patient with gastrointestinal ulceration due to an increased risk of bowel perforation.

However, alternative treatments such as glucocorticoid and nonsteroidal anti-inflammatory drugs may carry a higher bowel perforation risk.

The presence of gastrointestinal ulceration therefore should not constitute an absolute contraindication for Tocilizumab therapy.

Future studies of registry data will inform clinician of the Tocilizumab-related risk of gastrointestinal toxicity in “real-life” settings.

Contrary to previous case report, we found Tocilizumab therapy to have a positive effect on UC.

Laboratory studies supported a role for interleukin-6 in the pathophysiology of UC.

Further clinical trial to evaluate the therapeutic role of Tocilizumab in UC would be warranted.