Two cases of rheumatoid arthritis for which switching from tocilizumab to sarilumab
2021 Volume 33 Issue 4 Pages 329-337
Details
2021 Volume 33 Issue 4 Pages 329-337
Case 1: The patient was a 69-year-old man with rheumatoid arthritis. He had diabetes mellitus and started insulin. He achieved clinical remission（CR）with etanercept（ETN, 50mg/week）. He started sitagliptin and discontinued insulin. ETN lost its efficacy and golimumab was started, but since it was not effective, tocilizumab（TCZ, 162mg/2 weeks）was started and he achieved a CR again, which was maintained for 7 years. When TCZ lost its efficacy, sarilumab（SAR, 200mg/2 weeks）was started. Along with the amelioration of the patient’s RA activity, his hemoglobin A1c value improved.
Case 2: The patient was a 56-year-old man with RA. He maintained low disease activity with disease-modifying antirheumatic drugs including methotrexate（MTX, 16mg/week）and adalimumab（ADA, 40mg/2 weeks）, but he stopped all treatment due to financial reasons. One year later, he experienced a RA flare-up and visited our rheumatic center again. Considering the medical cost, MTX（16mg/week）, prednisolone（5mg/day）, and TCZ（162mg/2 weeks）were started. However, he developed severe vertigo with TCZ, and SAR（150mg/2 weeks, then 200mg/2 weeks）was started. This was effective and was not associated with side effects. SAR was effective for secondary failure and for overcoming the side effects of TCZ.
