OBJECTIVES: To present three cases of adult-onset still’s disease (AOSD) who was initially refractory to corticosteroid therapy but were successfully treated with an interleukin-6 (IL-6) inhibitor, tocilizumab (TCZ). BACKGROUND: Adult-onset Still’s Disease (AOSD) is a systemic inflammatory disorder of unknown etiology characterized by quotidian fever, evanescent rash, and arthritis/arthralgia. The pro-inflammatory cytokine interleukin (IL) – 6 has been implicated in its pathogenesis. CASE PRESENTATION: Three patients (40F, 37F, and 27M) presented with quotidian fever, evanescent maculopapular rash, arthritis, anemia, leukocytosis, elevated acute phase reactants and hyperferritinemia of 3 to 4 months duration. All were diagnosed AOSD by Yamaguchi criteria after extensive work up to exclude other diagnostic possibilities. Each patient received high dose corticosteroids and 2 patients also received methotrexate (MTX) with initial improvement of symptoms. However, there was recurrence and exacerbation of clinical symptoms on tapering of steroid doses. Each patient was then given TCZ at 8 mg/kg. Within a month of the initial dose of TCZ, there was dramatic clinical and laboratory improvement, enabling rapid steroid dose tapering. CONCLUSION This series substantiates the role of IL-6 in the pathomechanisms of AOSD and demonstrates use of TCZ in the management of AOSD refractory to corticosteroids.
Interleukin-6

No abstract available.
Interleukin-6* ; Myxoma*

No abstract available.
Interleukin-6* ; Rabbits*

No abstract available.
Interleukin-6* ; Lymphocytes*

No abstract available.
Interleukin-6* ; Meningitis, Aseptic*

No abstract available.
Hypertrophy* ; Interleukin-6* ; Podocytes*

No abstract available.
Fibrosis* ; Interleukin-6*

Background: Severe and critical COVID-19 disease is characterized by hyperinflammation involving pro-inflammatory cytokines, particularly IL-6. Tocilizumab is a monoclonal antibody that blocks IL-6 receptors. Objectives: This study evaluated the efficacy of tocilizumab in Filipino patients with severe to critical COVID-19 disease. Methods: This phase 3 randomized double-blind trial, included patients hospitalized for severe or critical COVID-19 in a 1:1 ratio to receive either tocilizumab plus local standard of care or placebo plus standard of care. Patients were eligible for a repeat IV infusion within 24-48 hours if they deteriorated or did not improve. Treatment success or clinical improvement was defined as at least two categories of improvement from baseline in the WHO 7-point Ordinal Scale of patient status, in an intention-to-treat manner. Results: Forty-nine (49) patients were randomized in the tocilizumab arm and 49 in the placebo arm. There was no significant difference in age, comorbidities, COVID-19 severity, need for mechanical ventilation, presence of acute respiratory distress syndrome, or biomarker levels between groups. Use of adjunctive therapy was similar between groups, with corticosteroid used in 91.8% in tocilizumab group and 81.6% in the placebo group, while remdesivir was used in 98% of participants in both groups. There was no significant difference between groups in terms of treatment success in both the intention-to-treat analysis (relative risk=1.05, 95% CI: 0.85-1.30) and per-protocol analysis (relative risk=0.98, 95% CI: 0.80 to 1.21). There was no significant difference in time to improvement of at least two categories relative to baseline on the 7-point Ordinal Scale of clinical status. Conclusion The use of tocilizumab on top of standard of care in the management of patients with severe to critical COVID-19 did not result in significant improvement as defined by the WHO 7-point Ordinal Scale of patient status, nor in significant improvement in incidence of mechanical ventilation, incidence of ICU admission, length of ICU stay, and mortality rate.
COVID-19 ; Interleukin-6

No abstract available.
Animals ; Ethanol* ; Interleukin-2* ; Interleukin-6* ; Rats*

No abstract available.
Animals ; Inflammation ; Interleukin-10 ; Interleukin-6 ; Rats