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Ann Rheum Dis 72:583-589 doi:10.1136/annrheumdis-2012-202470
  • Clinical and epidemiological research
  • Concise report

Blocking the effects of interleukin-6 in rheumatoid arthritis and other inflammatory rheumatic diseases: systematic literature review and meta-analysis informing a consensus statement

Open Access
  1. Josef S Smolen1,13
  1. 12nd Department of Medicine, Center for Rheumatic Disease, Hietzing Hospital, Vienna, Austria
  2. 2Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
  3. 3Department of Rheumatology and Clinical Immunology, Charité, Free University and Humboldt University, Berlin, Germany
  4. 4Department of Rheumatology, Cochin Hospital, René Descartes University, Paris, France
  5. 5Academic Unit of Musculoskeletal Diseases, Leeds University, Leeds, UK
  6. 6Division of Rheumatology and Internal Medicine—CIC, Catholic University of the Sacred Heart—School of Medicine, Rome, Italy
  7. 7Division of Rheumatology, University Hospital, University of Geneva, Geneva, Switzerland
  8. 8Hospital for Special Surgery, Weill Medical College of Cornell University, New York, New York, USA
  9. 9Department of Rheumatology Unit, Hospital Clinico Universitario, Santiago de Compostela, Santiago
  10. 10Musculoskeletal Unit, Menzies Research Institute, University of Tasmania, Hobart, Australia
  11. 11Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
  12. 12Laboratory of Immune Regulation, Wakayama Medical University, Wakayama, Japan
  13. 13Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Vienna, Austria
  1. Correspondence to Dr Monika M Schoels, 2nd Department of Internal Medicine, Center for Rheumatic Diseases, Hietzing Hospital, Wolkersbergenstrasse 1, Vienna 1130, Austria; monika.schoels{at}live.com
  • Accepted 14 October 2012
  • Published Online First 10 November 2012

Abstract

Background Suppression of the immunoinflammatory cascade by targeting interleukin 6 (IL-6) mediated effects constitutes a therapeutic option for chronic inflammatory diseases. Tocilizumab is the only IL-6 inhibitor (IL-6i) licensed for rheumatoid arthritis (RA) and juvenile idiopathic arthritis (JIA), but also other agents targeting either IL-6 or its receptor are investigated in various indications.

Objective To review published evidence on safety and efficacy of IL-6i in inflammatory diseases.

Methods We performed systematic literature searches in Medline and Cochrane, screened EULAR and American College of Rheumatology meeting-abstracts, and accessed http://www.clinicaltrials.gov.

Results Comprehensive evidence supports the efficacy of tocilizumab in RA in DMARD-naïve patients, and after DMARD- and TNFi-failure. Randomised comparisons demonstrate superiority of tocilizumab in JIA, but not ankylosing spondylitis (AS). Other indications are currently investigated. Additional IL-6i show similar efficacy; safety generally appears acceptable.

Conclusions IL-6i is effective and safe in RA and JIA, but not in AS. Preliminary results in other indications need substantiation.

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