Kameda Hideto, Maezawa Reina, Minegishi Yasuto, Imaizumi Chihiro, Katagiri Takaharu, Ogura Takehisa
Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Toho University (Ohashi Medical Center), Tokyo, Japan.
Drugs Aging. 2025 Sep 5. doi: 10.1007/s40266-025-01248-8.
Interleukin (IL)-6 plays a central role in amplifying inflammation, and its inhibition is beneficial in managing immune-mediated inflammatory diseases (IMIDs) such as rheumatoid arthritis (RA). IL-6 signaling inhibition is associated with a slightly increased risk of infections in patients with RA, and older age has been identified as a risk factor for severe adverse events, including infections. Therefore, the combination of an aging population and the increasing use of IL-6R inhibitors in RA treatment highlights the importance of carefully evaluating the safety and effectiveness of these therapies in older patients with RA. Recent postmarketing surveillance (PMS) data on the safety and effectiveness of sarilumab (SAR) in Japanese patients with RA, along with PMS data from Japan and registry data from France and Germany of tocilizumab (TCZ), provide valuable insights for both current and future management of RA. These data suggest that anti-IL-6R therapies are generally well tolerated among older patients with RA and do not appear to increase the risk of cardiovascular events or malignancies. While the effectiveness of TCZ was somewhat lower in older patients compared with younger ones, the effectiveness of SAR was similar across age groups. Consequently, the use of anti-IL-6R antibodies is anticipated to expand to other IMIDs beyond RA, particularly in increasingly superaged societies worldwide.
白细胞介素（IL）-6在放大炎症反应中起核心作用，抑制IL-6对治疗免疫介导的炎症性疾病（IMID）如类风湿关节炎（RA）有益。抑制IL-6信号传导与RA患者感染风险略有增加相关，且年龄较大已被确定为包括感染在内的严重不良事件的一个危险因素。因此，老龄化人口以及RA治疗中IL-6R抑制剂使用的增加凸显了在老年RA患者中仔细评估这些疗法安全性和有效性的重要性。最近关于日本RA患者中sarilumab（SAR）安全性和有效性的上市后监测（PMS）数据，以及来自日本的PMS数据和法国及德国的托珠单抗（TCZ）登记数据，为RA的当前和未来管理提供了有价值的见解。这些数据表明，抗IL-6R疗法在老年RA患者中总体耐受性良好，且似乎不会增加心血管事件或恶性肿瘤的风险。虽然与年轻患者相比，老年患者中TCZ的有效性略低，但SAR的有效性在各年龄组中相似。因此，预计抗IL-6R抗体的使用将扩展到RA以外的其他IMID，特别是在全球老龄化日益严重的社会中。
