Consensus statement on blocking interleukin-6 receptor and interleukin-6 in inflammatory conditions: an update

Abstract

BackgroundTargeting interleukin (IL)-6 has become a major therapeutic strategy in the treatment of immune-mediated inflammatory disease. Interference with the IL-6 pathway can be directed at the specific receptor using anti-IL-6Rα antibodies or by directly inhibiting the IL-6 cytokine. This paper is an update of a previous consensus document, based on most recent evidence and expert opinion, that aims to inform on the medical use of interfering with the IL-6 pathway.MethodsA systematic literature research was performed that focused on IL-6-pathway inhibitors in inflammatory diseases. Evidence was put in context by a large group of international experts and patients in a subsequent consensus process. All were involved in formulating the consensus statements, and in the preparation of this document.ResultsThe consensus process covered relevant aspects of dosing and populations for different indications of IL-6 pathway inhibitors that are approved across the world, including rheumatoid arthritis, polyarticular-course and systemic juvenile idiopathic arthritis, giant cell arteritis, Takayasu arteritis, adult-onset Still’s disease, Castleman’s disease, chimeric antigen receptor-T-cell-induced cytokine release syndrome, neuromyelitis optica spectrum disorder and severe COVID-19. Also addressed were other clinical aspects of the use of IL-6 pathway inhibitors, including pretreatment screening, safety, contraindications and monitoring.ConclusionsThe document provides a comprehensive consensus on the use of IL-6 inhibition to treat inflammatory disorders to inform healthcare professionals (including researchers), patients, administrators and payers.

Diagnosis and treatment of adult-onset Still’s disease: a concise summary of the German society of rheumatology S2 guideline

“…However, at the same time, trends towards effectiveness of the respective cytokine blockade were shown, and important secondary endpoints were met [91, 94,153]. The body of evidence supporting cytokine blockade is substantially better in children with Still's disease (sJIA) [6,156]. Licensing of canakinumab and anakinra in adults is also based on the assumption that AOSD and sJIA represent the same disease, with age-specific variation in clinical presentation and prognosis.…”

Bioinspired Asymmetric Double-Layer Dressings for Stepwise Treatment of Hemorrhagic Wounds

“…Scanning electron microscopy (SEM, Figure d) further revealed that there were fewer and larger pores in the thick BSP layer, in remarkable contrast to the denser and smaller micropores in the thin PNS@CMCS layer. The cross-linking degree of hydrogels and solid contents have been recognized as critical factors to affect the microstructure and pore sizes of lyophilized hydrogel sponges. , In our study, the BSP-containing carbomer sponges with less carbomer content even showed more loose porous structures (Figure S2), indicating the loose cross-linking and low solid contents in the BSP layer. By contrast, the lyophilized PNS-containing CMCS hydrogels with the higher alginate contents showed denser structures (Figure S3), suggesting a large cross-linking degree and high solid contents in the BSP layer.…”

Clinical characteristics of unvaccinated or incompletely vaccinated children with neurological manifestations due to SARS‐CoV‐2 Omicron infection

“…17 Immunologically, cytokines such as IL-6 and IL-8 are pivotal in the generation of acute systemic inflammatory response. 18,19 A skewed cytokine profile towards IL-6 and IL-8 was associated with cardiac dysfunction in children with multisystem inflammatory syndrome (MIS-C). 20 However, another study showed that plasma IL-6 level failed to discriminate children with MIS-C with or without shock.…”

“…Three of the five children had markedly raised blood IL‐6 level, suggesting that the severe neurological symptoms might be related to immunodysregulation rather than direct neuroinvasion 17 . Immunologically, cytokines such as IL‐6 and IL‐8 are pivotal in the generation of acute systemic inflammatory response 18,19 . A skewed cytokine profile towards IL‐6 and IL‐8 was associated with cardiac dysfunction in children with multisystem inflammatory syndrome (MIS‐C) 20 .…”