title: Blocking the effects of interleukin-6 in rheumatoid arthritis and other inflammatory rheumatic diseases: systematic literature review and meta-analysis informing a consensus statement.
abstract: BACKGROUND
  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.
  
  
  OBJECTIVE
  To review published evidence on safety and efficacy of IL-6i in inflammatory diseases.
  
  
  METHODS
  We performed systematic literature searches in Medline and Cochrane, screened EULAR and American College of Rheumatology meeting-abstracts, and accessed http://www.clinicaltrials.gov.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  IL-6i is effective and safe in RA and JIA, but not in AS. Preliminary results in other indications need substantiation.
authors.affiliation: Correspondence to Dr Monika M Schoels, 2nd Department of Internal Medicine, Center for Rheumatic Diseases, Hietzing Hospital, Wolkersbergenstrasse 1, Vienna 1130, Austria. monika.schoels@live.com
authors.forename: Monika M
authors.initials: MM
authors.lastname: Schoels
authors.forename: Désirée
authors.initials: D
authors.lastname: van der Heijde
authors.forename: Ferdinand C
authors.initials: FC
authors.lastname: Breedveld
authors.forename: Gerd R
authors.initials: GR
authors.lastname: Burmester
authors.forename: Maxime
authors.initials: M
authors.lastname: Dougados
authors.forename: Paul
authors.initials: P
authors.lastname: Emery
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Ferraccioli
authors.forename: Cem
authors.initials: C
authors.lastname: Gabay
authors.forename: Allan
authors.initials: A
authors.lastname: Gibofsky
authors.forename: Juan Jesus
authors.initials: JJ
authors.lastname: Gomez-Reino
authors.forename: Graeme
authors.initials: G
authors.lastname: Jones
authors.forename: Tore K
authors.initials: TK
authors.lastname: Kvien
authors.forename: Miho
authors.initials: M
authors.lastname: Murakami
authors.forename: Miho M
authors.initials: MM
authors.lastname: Murikama
authors.forename: Norihiro
authors.initials: N
authors.lastname: Nishimoto
authors.forename: Josef S
authors.initials: JS
authors.lastname: Smolen
mesh_terms: D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use*; D018501:Antirheumatic Agents / Q000627:therapeutic use; D001171:Arthritis, Juvenile / Q000188:drug therapy* / Q000276:immunology; D001172:Arthritis, Rheumatoid / Q000188:drug therapy* / Q000276:immunology; D032921:Consensus; D006801:Humans; D015850:Interleukin-6 / Q000276:immunology; D013167:Spondylitis, Ankylosing / Q000188:drug therapy* / Q000276:immunology; D000093242:Interleukin-6 Inhibitors
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D018501:Antirheumatic Agents; D015850:Interleukin-6; D000093242:Interleukin-6 Inhibitors; C508600:IL6 protein, human; C502936:tocilizumab