Compounds that target interleukin (IL)−6 pathways include antibodies against the IL-6 receptor or ligand, and inhibitors of IL-6 signal transduction. The anti-IL-6 receptor (IL-6R) monoclonal antibody tocilizumab has been licensed for several years; data from multiple studies demonstrate its efficacy and tolerability in rheumatoid arthritis as monotherapy or in combination with methotrexate. In addition, another anti-IL-6R monoclonal antibody, sarilumab, has recently been approved in both the US and EU. Anti-IL-6 monoclonal antibodies include olokizumab and clazakizumab, which both have data from phase II studies, as well as sirukumab which has completed phase III trials but may not be brought to the market. Comparative data for olokizumab versus tocilizumab intervention in rheumatoid arthritis suggest no difference in efficacy between blocking the receptor or the ligand. Head-to-head studies are needed to determine whether inhibition of the Janus kinase pathway is similar in its overall efficacy to direct inhibition of IL-6 or its receptor. The IL-6 inhibitors appear to be more effective when combined with methotrexate. However, they have shown superiority to tumour necrosis factor inhibitors when used as monotherapy, and may have an advantage in patients who cannot use methotrexate or any other conventional synthetic disease modifying anti-rheumatic drug. Regarding disease activity assessment, CDAI is a more appropriate measure than DAS28 when looking at the effect of IL-6 inhibition, as these agents interfere with the acute phase response, which is heavily weighted in the formula of DAS28.

中文翻译：

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靶向IL-6：数据回顾

靶向白介素（IL）-6途径的化合物包括针对IL-6受体或配体的抗体，以及IL-6信号转导的抑制剂。抗IL-6受体（IL-6R）单克隆抗体tocilizumab已获许可多年；多项研究的数据表明，作为单一疗法或与甲氨蝶呤联用，其在类风湿关节炎中的疗效和耐受性。此外，另一种抗IL-6R单克隆抗体sarilumab最近已在美国和欧盟获得批准。抗IL-6单克隆抗体包括olokizumab和clazakizumab，两者均具有II期研究的数据，以及sirukumab，其已完成III期临床试验，但可能不会投放市场。类风湿关节炎中olokizumab与tocilizumab干预的比较数据表明，阻断受体或配体的疗效无差异。需要进行面对面的研究来确定对Janus激酶途径的抑制在总体功效上是否与直接抑制IL-6或其受体相似。与甲氨蝶呤联用时，IL-6抑制剂似乎更有效。但是，它们在用作单一疗法时已显示出优于肿瘤坏死因子抑制剂的优势，并且在无法使用甲氨蝶呤或任何其他常规合成抗风湿药的患者中可能具有优势。关于疾病活动性评估，在观察IL-6抑制作用时，CDAI比DAS28更合适，因为这些药物会干扰急性期反应，