Berman Mark, Ben-Ami Ronen, Berliner Shlomo, Anouk Marina, Kaufman Ilana, Broyde Adi, Borok Sara, Elkayam Ori
Department of Rheumatology, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel.
Infectious Disease Unit, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel.
Life (Basel). 2021 Mar 20;11(3):258. doi: 10.3390/life11030258.
The human anti-IL-6 receptor antibody tocilizumab (TCZ) has been approved for the treatment of rheumatoid arthritis (RA) and giant cell arteritis (GCA). It is observed that CRP levels drop quickly after starting TCZ treatment. This may lead to misinterpretation of laboratory results when accessing the patient with infectious disease while on TCZ. We conducted this study to report cases treated with tocilizumab who developed serious infections with special reference to levels of CRP and to review the literature on the effect of tocilizumab on acute phase response (APR) during infections.
The files of RA and GCA patients hospitalized in the Tel Aviv medical center between 2009-2019 were reviewed. Cases of patients with RA and GCA treated with tocilizumab who were hospitalized due to severe infections were reviewed with special emphasis on the duration of treatment, type of infection, and APR.
We identified nine admissions. Seven patients were treated with tocilizumab for RA, two for GCA. The diagnosis was pneumonia in three cases, osteomyelitis in one, cellulitis in one, endocarditis due to Whipple disease in one, abscess of cervix uteri in one, meningitis in one, and perforated diverticulitis in one. The mean CRP levels on admission were 4.75 mg/L (normal range, up to 5 mg/L). All cases were diagnosed correctly on admission.
CRP levels may not correctly reflect the severity of infectious diseases during tocilizumab treatment. Increased awareness of the masking effect of tocilizumab on the APR during infection is needed in order to avoid a delay in the diagnosis.
人抗白细胞介素-6受体抗体托珠单抗（TCZ）已被批准用于治疗类风湿关节炎（RA）和巨细胞动脉炎（GCA）。观察到开始使用托珠单抗治疗后CRP水平迅速下降。这可能导致在使用托珠单抗治疗的传染病患者进行实验室检查时对检查结果产生误解。我们开展这项研究以报告使用托珠单抗治疗并发生严重感染的病例，特别提及CRP水平，并回顾关于托珠单抗对感染期间急性期反应（APR）影响的文献。
回顾了2009年至2019年在特拉维夫医疗中心住院的RA和GCA患者的病历。对因严重感染住院的接受托珠单抗治疗的RA和GCA患者病例进行了回顾，特别强调治疗持续时间、感染类型和APR。
我们确定了9例住院病例。7例患者因RA接受托珠单抗治疗，2例因GCA接受治疗。诊断为肺炎3例，骨髓炎1例，蜂窝织炎1例，惠普尔病所致心内膜炎1例，子宫颈脓肿1例，脑膜炎1例，穿孔性憩室炎1例。入院时CRP平均水平为4.75mg/L（正常范围，最高5mg/L）。所有病例入院时均被正确诊断。
在托珠单抗治疗期间，CRP水平可能无法正确反映传染病的严重程度。需要提高对托珠单抗在感染期间对APR的掩盖作用的认识，以避免诊断延误。
