**4.5 Tocilizumab**

Tocilizumab is an interleukin-6 (IL-6)-receptor inhibitor. The Giant Cell Arteritis Actemra (GiACTA) trial demonstrated increased rates of sustained remission using a combination of tocilizumab plus corticosteroids compared with those treated with corticosteroids alone [21]. Furthermore, steroid-induced adverse effects were reduced with the usage of tocilizumab for treatment.

Tocilizumab is recommended by NICE as an option for treating GCA in adults, in case they have relapsing, or refractory disease and they have not already taken tocilizumab; it is stopped after one year of uninterrupted treatment at most [20].

Tocilizumab is a potent suppressor of IL-6, which is important producer of CRP. Therefore, patients on tocilizumab may not produce a biochemical inflammatory response in the setting of infection/inflammation. Caution should be taken while taking Tocilizumab, particularly in patients with a history of diverticulitis, as it carries a risk for gastrointestinal perforation [22].
