Targeting interleukin-6 in pediatric rheumatic diseases.
OBJECTIVE
To describe the most recent data regarding the role of interleukin-6 (IL-6) in immune and inflammatory responses, the mode of action and safety information on tocilizumab, the only available IL-6 inhibitor, and discuss recent results on the therapeutic inhibition of IL-6 in pediatric rheumatic diseases.


RESULTS
New data on the effects of IL-6 on T and B cells have been published. Clinical trials with tocilizumab in adults, particularly with rheumatoid arthritis, provide new data on mechanism of action and a reasonably wide safety database. A withdrawal design trial showed marked efficacy in systemic juvenile idiopathic arthritis (s-JIA). Open label studies or anecdotal reports suggest possible efficacy also in other JIA subtypes, as well as other rheumatic diseases.


CONCLUSIONS
Targeting IL-6 activities is an effective approach in the treatment of chronic inflammatory diseases. The long-term benefit and safety of tocilizumab have to be defined in long-term extension studies. The risk/benefit ratio appears to be particularly favorable in s-JIA. With the increasing number of biologics becoming available, future efforts should be directed to the definition of biomarkers that will identify responders to each novel biologic, allowing a personalized approach.
De Benedetti
Fabrizio
F
IRCCS Ospedale Pediatrico Bambino Gesù, Rome, Italy. fabrizio.debenedetti@opbg.net
D000328:Adult; D000911:Antibodies, Monoclonal / Q000009:adverse effects / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized; D001171:Arthritis, Juvenile / Q000276:immunology / Q000628:therapy; D002648:Child; D006801:Humans; D015850:Interleukin-6 / Q000276:immunology; D019947:Receptors, Interleukin-6 / Q000037:antagonists & inhibitors / Q000276:immunology; D012216:Rheumatic Diseases / Q000276:immunology* / Q000628:therapy*; D000093242:Interleukin-6 Inhibitors
D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D015850:Interleukin-6; D019947:Receptors, Interleukin-6; D000093242:Interleukin-6 Inhibitors; C508600:IL6 protein, human; C502936:tocilizumab