IL-6 inhibitor for the treatment of rheumatoid arthritis: A comprehensive review

Abstract

Tocilizumab (TCZ) is an interleukin-6 (IL-6) inhibitor used for the treatment of rheumatoid arthritis (RA). It was developed in 2008, and its effectiveness is supported by evidence from all over the world based on its first decade of use. Although the overall efficacy and safety profiles of TCZ are similar to those of tumor necrosis factor (TNF) inhibitors, TCZ displays certain differences. The most notable advantage of TCZ is its usefulness as a monotherapy. Additionally, TCZ is favorable in the improvement of systemic inflammatory symptoms such as anemia and fatigue. The low immunogenicity of TCZ contributes favorably to long-term drug retention. Due to frequent relapse after TCZ cessation, TCZ use should be tapered beyond remission. During TCZ therapy, C-reactive protein (CRP) is unable to recognize disease activity and the severity of infection. The most common adverse events (AEs) are infection and abnormalities in laboratory findings including dyslipidemia, neutropenia, thrombocytopenia, and abnormality of liver enzymes. TCZ obscures the symptoms of infection. Therefore, stealth infections without obvious CRP elevation can sometimes cause severe damage to patients. Lower intestinal perforation is an uncommon but serious AE in TCZ therapy. Further clinical investigations will continue to refine the IL-6 inhibitory strategy.

CYR61 synthesis is Induced by Interleukin-6 and Promotes Migration and Invasion of Fibroblast-like Synoviocytes in Rheumatoid Arthritis

“…Our results suggest that increased IL-6 levels promote FLS phenotype transition to tumour-like patterns that are responsible for the vicious cycle of cytokine and chemokine production. These ndings are consistent with the nding that IL-6 stimulates tumour-like proliferation of FLSs in RA [21] and indicate that tumour progression mechanisms could account for pannus formation and function.…”

Biologika und „small molecules“ bei der rheumatoiden Arthritis

“…Die spezifischen Nebenwirkungen der IL-6-Hemmung sind abgesehen von einer erhöhten Infektneigung Veränderungen des Blutbildes und der Leberwerte, eine Erhöhung des Cholesterins und, initial überraschend, eine erhöhte Inzidenz an Darmperforationen, besonders bei Divertikulitis [34], weswegen diese Medikamente bei Patienten mit einer Divertikulitis in der Anamnese nur mit großer Vorsicht eingesetzt werden sollten.…”

Therapeutic Potential of Dental Pulp Stem Cells and Leukocyte- and Platelet-Rich Fibrin for Osteoarthritis

“…Therefore, therapeutic targeting IL-6 has become important in the drug development applications of these diseases. Tocilizumab (TCZ), an IL-6 receptor-inhibiting monoclonal antibody, is widely used in the treatment of RA [72]. However, the role of IL-6 in OA remains unclear.…”