Correspondence to Dr Monika M Schoels, 2nd Department of Internal Medicine, Center for Rheumatic Diseases, Hietzing Hospital, Wolkersbergenstrasse 1, Vienna 1130, Austria.
Ann Rheum Dis. 2013 Apr;72(4):583-9. doi: 10.1136/annrheumdis-2012-202470. Epub 2012 Nov 10.
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.
To review published evidence on safety and efficacy of IL-6i in inflammatory diseases.
We performed systematic literature searches in Medline and Cochrane, screened EULAR and American College of Rheumatology meeting-abstracts, and accessed http://www.clinicaltrials.gov.
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.
IL-6i is effective and safe in RA and JIA, but not in AS. Preliminary results in other indications need substantiation.
通过靶向白介素 6（IL-6）介导的作用抑制免疫炎症级联反应，为慢性炎症性疾病提供了一种治疗选择。托珠单抗是唯一被批准用于类风湿关节炎（RA）和幼年特发性关节炎（JIA）的 IL-6 抑制剂（IL-6i），但其他针对 IL-6 或其受体的药物也在各种适应证中进行了研究。
综述 IL-6i 在炎症性疾病中的安全性和疗效的已发表证据。
我们在 Medline 和 Cochrane 进行了系统的文献检索，筛选了 EULAR 和美国风湿病学会会议摘要，并访问了 http://www.clinicaltrials.gov。
全面的证据支持托珠单抗在初治 DMARD 患者和 DMARD 和 TNFi 失败后的 RA 中的疗效。随机对照比较表明托珠单抗在 JIA 中具有优越性，但在 AS 中没有。其他适应证目前正在研究中。其他 IL-6i 显示出相似的疗效；安全性通常是可以接受的。
IL-6i 在 RA 和 JIA 中有效且安全，但在 AS 中无效。其他适应证的初步结果需要进一步证实。
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