Some preliminary notes on Tocilizumab and Crohn’s Disease plus Rheumatoid Arthritis

Some people suffer from more than one autoimmune disease, e.g. rheumatoid arthritis and Crohn’s, psoriatic arthritis and psoriasis vulgaris (might also be looked at as two facettes of one disease). Sometimes you treat both diseases with one biologic.
How about tocilizumab in rheumatoid arthritis and Crohn’s? There hasn’t been much on Crohn’s and tocilizumab so far!


In 2000 a German study by R. Atreya et al. saw a promising target in blocking interleukin-6: “Blockade of interleukin 6 trans signaling suppresses T-cell resistance against apoptosis in chronic intestinal inflammation: Evidence in Crohn disease and experimental colitis in vivo”. http://www.nature.com/nm/journal/v6/n5/abs/nm0500_583.html  


In 2003 H. Ito discussed interleukin-6 as a possible and promising target in Crohn’s. http://www.ncbi.nlm.nih.gov/pubmed/12570822  


But in 2004 Ito published a pilot study: “Ito H, Takazoe M, Fukuda Y, Hibi T, Kusugami K, Andoh A, et al. A pilot randomized trial of a human anti-interleukin-6 receptor monoclonal antibody in active Crohn's disease. Gastroenterol. 2004;126:989–996.“ Ito et al. concluded: “A biweekly 8 mg/kg infusion of MRA [that is tocilizumab] was well tolerated, normalized the acute-phase responses, and suggests a clinical effect in active Crohn's disease.” But in results you find the following statement: “Endoscopic and histologic examination showed no difference between MRA and placebo groups.” http://www.ncbi.nlm.nih.gov/pubmed/15057738

To sum it up, Chugai/Roche haven’t studied further Crohn’s as a field for tocilizumab. Crohn’s might get better, but the indication should be rheumatoid arthritis. At least the pilot study didn’t show any safety concerns coming from Crohn’s.