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Tocilizumab Lipid Management — SCE Rheumatology MCQ

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ModerateRheumatology PharmacologyTocilizumab Lipid ManagementSCE Rheumatology

A 55-year-old woman with RA on Tocilizumab has her lipid profile checked 8 weeks after starting treatment as per BSR guidelines. Her total cholesterol has risen from 5.2 to 7.1 mmol/L. Should Tocilizumab be stopped?

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Correct answer: D — No Tocilizumab-induced dyslipidaemia should be managed with statins according to standard cardiovascular risk guidelines rather than stopping Tocilizumab

Tocilizumab-associated dyslipidaemia is a class effect of IL-6 receptor inhibitors managed by treating the lipid abnormality rather than stopping the biologic. BSR biologic safety guidelines recommend lipid monitoring at 4-8 weeks after starting Tocilizumab and management with statins according to cardiovascular risk assessment. Despite lipid increases the overall cardiovascular risk profile on Tocilizumab appears neutral as effective RA inflammation control independently reduces cardiovascular risk. The lipid changes are dose-dependent and related to reduced hepatic LDL receptor expression from IL-6 pathway blockade.

Reference: BSR 2019 biologic safety guidelines; McInnes IB et al 2015 cardiovascular safety of Tocilizumab