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IL-6 blockade in the management of non-infectious uveitis

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Abstract

Several pathogenetic studies have paved the way for a newer more rational therapeutic approach to non-infectious uveitis, and treatment of different forms of immune-driven uveitis has drastically evolved in recent years after the advent of biotechnological drugs. Tumor necrosis factor-α targeted therapies, the first-line recommended biologics in uveitis, have certainly led to remarkable results in patients with non-infectious uveitis. Nevertheless, the decision-making process turns out to be extremely difficult in anti-tumor necrosis factor or multidrug-resistant cases. Interleukin (IL)-6 holds a critical role in the pathogenic pathways of uveitis, due to its extended and protean range of effects. On this background, manipulation of IL-6 inflammatory cascade has unraveled encouraging outcomes. For instance, rising evidence has been achieved regarding the successful use of tocilizumab, the humanized monoclonal antibody targeted against the IL-6 receptor, in treating uveitis related to juvenile idiopathic arthritis or Behçet’s disease. Similar findings have also been reported for uveitis associated with systemic disorders, such as rheumatoid arthritis or multicentric Castleman disease, but also for idiopathic uveitis, the rare birdshot chorioretinopathy, and even in cases complicated by macular edema. This work provides a digest of all current experiences and evidences concerning IL-6 blockade, as suggested by the medical literature, proving its potential role in the management of non-infectious uveitis.

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  1. Donato Rigante and Luca Cantarini equally contributed to this manuscript.

Authors and Affiliations

  1. Department of Emergency and Organ Transplantation, Rheumatology Unit, Bari, Italy

    Giuseppe Lopalco & Florenzo Iannone

  2. Department of Ophthalmology, Humanitas Clinical and Research Center, Milan, Italy

    Claudia Fabiani

  3. Research Center of Systemic Autoinflammatory Diseases and Behçet’s Disease and Rheumatology-Ophthalmology Collaborative Uveitis Center, Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Siena, Italy

    Jurgen Sota, Orso Maria Lucherini, Bruno Frediani, Mauro Galeazzi & Luca Cantarini

  4. Ophthalmology Unit of the Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy

    Gian Marco Tosi & Rossella Franceschini

  5. Institute of Pediatrics, Università Cattolica Sacro Cuore, Fondazione Policlinico Universitario “A. Gemelli”, Rome, Italy

    Donato Rigante

  6. Rheumatology Unit, Policlinico “Le Scotte”, University of Siena, viale Bracci 1, 53100, Siena, Italy

    Luca Cantarini

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  1. Giuseppe Lopalco
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Correspondence to Claudia Fabiani or Luca Cantarini.

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Lopalco, G., Fabiani, C., Sota, J. et al. IL-6 blockade in the management of non-infectious uveitis. Clin Rheumatol 36, 1459–1469 (2017). https://doi.org/10.1007/s10067-017-3672-z

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