Interleukin 6 Receptor Blockade to Treat Chronic Active Antibody-Mediated Rejection in Kidney Transplant: A Case Report With Review of Relevant Literature

Anti-interleukin-6 Antibody Clazakizumab in Antibody-mediated Renal Allograft Rejection: Accumulation of Antibody-neutralized Interleukin-6 Without Signs of Proinflammatory Rebound Phenomena

“…16 Therapeutic antibodies targeting the IL-6/IL-6R axis-well established in the treatment of rheumatoid arthritis [17][18][19] -are of increasing interest in transplant medicine. [11][12][13][20][21][22][23] Several uncontrolled studies and anecdotal reports have suggested that IL-6R blockade using tocilizumab in patients with ongoing AMR stabilizes renal function, modulates DSA levels, and improves histopathologic findings. 11,[20][21][22] Treatment with tocilizumab, however, promotes substantial accumulation of free IL-6 and soluble IL-6R in the circulation, which may confer a risk of rebound phenomena after cessation of treatment.…”

“…[11][12][13][20][21][22][23] Several uncontrolled studies and anecdotal reports have suggested that IL-6R blockade using tocilizumab in patients with ongoing AMR stabilizes renal function, modulates DSA levels, and improves histopathologic findings. 11,[20][21][22] Treatment with tocilizumab, however, promotes substantial accumulation of free IL-6 and soluble IL-6R in the circulation, which may confer a risk of rebound phenomena after cessation of treatment. [24][25][26] This accumulation probably has clinical relevance: Choi et al 11 reported 4 graft losses that occurred after premature cessation of tocilizumab in a series of 32 patients treated for AMR.…”