Analysis of data from a German registry of patients with rheumatoid arthritis (RA; n = 13,310) identifies tocilizumab use as a risk factor associated with lower intestinal perforation (LIP), which has been reported as a rare but serious complication in clinical trials of this drug. The incidence of LIP was significantly higher in patients receiving toclilizumab (2.7 events per 1,000 person-years) than in those receiving conventional or biologic DMARDs (0.2–0.6 events per 1,000 person-years). Some patients with tocilizumab-induced LIP displayed only minor symptoms and most did not show elevation of C-reactive protein levels. Notably, the 30-day mortality rate among patients with LIP was 46%, emphasizing the importance of closely monitoring patients receiving tocilizumab for gastrointestinal events.
References
Strangfeld, A. et al. Risk for lower intestinal perforations in patients with rheumatoid arthritis treated with tocilizumab in comparison to treatment with other biologic or conventional synthetic DMARDs. Ann. Rheum. Dis. http://dx.doi.org/10.1136/annrheumdis-2016-209773 (2016)
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Shipman, L. Tocilizumab and the risk of intestinal perforation. Nat Rev Rheumatol 12, 499 (2016). https://doi.org/10.1038/nrrheum.2016.130
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DOI: https://doi.org/10.1038/nrrheum.2016.130