Inhibition of interleukin 6 in immune inflammatory rheumatic diseases: achievements, prospects, and hopes

Much attention has been recently paid to the study of interleukin 6 (IL-6) among the cytokines involved in the development of immune inflammatory rheumatic diseases (IIRDs). The introduction of monoclonal antibodies that inhibit the activity of IL-6 (tocilizumab, TCZ) in clinical practice in 2010 is one of the biggest advances in IIRD treatment in the early 21st century. IL-6 inhibition is now regarded as one of the most promising areas in the treatment of rheumatoid arthritis (RA), many other inflammatory diseases, and malignant neoplasms. The data obtained in international studies are confirmed by extensive Russian experience with TCZ used to treat RA in the LORNET study that has established the rapid and steady-state clinical effect of the drug, better quality of life in the patients, slower progression of joint destruction, positive changes in the ultrasound signs of articular inflammation and in the immunological biomarkers of inflammatory activity and identified the immunological and immunogenetic predictors for the efficiency of the drug. There is recent evidence that TCZ is highly effective in treating large-vessel vasculitis - giant cell arteritis concurrent with polymyalgia rheumatica and Takayasu’s arteritis. Noteworthy are the achievements by the Russian scientists (BIOCAD) who have designed BCD-089 that is a human anti-IL-6 receptor monoclonal antibody. IL-6 inhibition is one of the most rapidly developing areas of pharmacotherapy for human IIRDs. Further deciphering the mechanisms determining the physiological and pathological effects of IL-6 along with the design of novel drugs that block the effects of this cytokine is of considerable importance for the progress of rheumatology and many other branches of modern medicine.