II. Mechanism
- Blockade of of IL-6 decreases production of proinflammatory Cytokines and acute phase reactants
III. Indications
- Severe Cytokine Release Syndrome (CRS)
- CAR T-Cell Therapy Related CRS (FDA approved use of Tocilizumab)
- COVID-19 related CRS (experimental Tocilizumab use in 2020)
- Multicentric Castleman’s disease (Siltuximab)
- Rheumatologic Conditions (Tocilizumab)
IV. Preparations
- Tocilizumab
- IL-6 receptor Antagonist (Monoclonal Antibody)
- Cytokine Release Syndrome Dosing: 8 mg/kg (up to 800 mg) or for <30 kg, use 12 mg/kg
- Sarilumab (Kevzara)
- Siltuximab (Sylvant)
- Binds IL-6 (Monoclonal Antibody)
V. Adverse Effects
- Severe infections (esp. opportunistic Viral Infections, Bacterial Infections, invasive fungal infections)
- Reactivated Herpes Zoster
- Reactivated Tuberculosis
- Neutropenia
- Thrombocytopenia
- Increased liver enzymes
- Hyperlipidemia
- GI perforation
VI. References
- Kamer and LoVecchio (2020) Crit Dec Emerg Med 34(8): 24