Interleukin (IL)−6 represents one of several possible targets for the treatment of rheumatoid arthritis. Drugs targeting IL-6 can be divided into monoclonal antibodies against IL-6 itself and monoclonal antibodies against the IL-6 receptor. Both types of agent inhibit both classical signalling through membrane­-bound IL-6 receptor, and trans-signalling via formation of a complex between IL-6 and soluble IL-6 receptor. The IL-6 receptor blockers tocilizumab and sarilumab inhibit the low affinity binding of IL-6 to its receptor. The anti-IL-6 agents clazakizumab and vobarilizumab also block binding of IL-6 to the receptor, while olokizumab blocks the higher affinity interaction of the IL-6-receptor complex with gp130. The doses and dosing intervals of the biologics targeting different elements vary, but no major differences in efficacy or safety have yet been seen between the two approaches, although more studies are needed in this area. In addition to the different blocking actions of monoclonal antibodies, we consider therapeutic strategies including the timing of IL-6 blockade and the use of monotherapy versus the addition of methotrexate.

中文翻译：

---

考虑关于在关节炎中使用IL-6抑制剂的新经验

白介素（IL）-6代表类风湿关节炎的几种可能靶标之一。靶向IL-6的药物可分为针对IL-6本身的单克隆抗体和针对IL-6受体的单克隆抗体。两种类型的药剂都通过膜结合的IL-6受体抑制经典信号传导，并通过在IL-6和可溶性IL-6受体之间形成复合物来抑制反信号传递。IL-6受体阻滞剂tocilizumab和sarilumab抑制IL-6与其受体的低亲和力结合。抗IL-6药物clazakizumab和vobarilizumab也阻断IL-6与受体的结合，而olokizumab阻断IL-6-受体复合物与gp130的更高亲和力相互作用。针对不同元素的生物制剂的剂量和给药间隔有所不同，但是，尽管在这方面还需要进行更多的研究，但两种方法在功效或安全性上尚无重大差异。除了单克隆抗体的不同阻断作用外，我们还考虑了治疗策略，包括IL-6阻断的时机，单一疗法的使用与甲氨蝶呤的添加。