ArticleAnnals of hematology2026
Interleukin-6 levels decrease following rituximab treatment but increase following tocilizumab treatment.
Article in Annals of hematology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Idiopathic multicentric Castleman disease (iMCD) is a rare, gradually progressive lymphoproliferative disorder thought to arise from chronic hypercytokinemia, with IL-6 playing a central role in disease manifestations. C-reactive protein (CRP) levels are widely used as a surrogate marker of IL-6 activity in clinical practice. Although anti-IL-6 therapies, such as tocilizumab, are established treatments for iMCD, spurious elevation of circulating IL-6 levels after IL-6 pathway blockade has been reported, complicating biomarker interpretation. In contrast, changes in IL-6 and CRP levels following rituximab therapy remain poorly characterized, and direct comparisons between these therapeutic approaches are limited. Therefore, this retrospective study measured serum IL-6 and CRP levels in 17 patients (12 men and five women; mean age, 45 years) with iMCD before and after treatment with rituximab (n = 8) and tocilizumab (n = 9). Paired t test were used to assess in-group differences. After rituximab therapy, CRP values decreased from 67.7 ± 55.5 (range: 1.0-174.9) to 25.8 ± 29.0 (range: 1.0-71.2) mg/L, while IL-6 values decreased from 25.6 ± 29.7 (range: 1.3-86.8) to 12.0 ± 11.2 (range: 0.8-31.0) pg/mL (normal range < 8.0), although these reductions were not statistically significant. In contrast, tocilizumab therapy resulted in a significant decrease in CRP values decreased from 68.9 ± 40.8 (range: 24.0-147.9) to 7.9 ± 9.8 (range: 0.1-30.5) mg/L (p < 0.05), while IL-6 levels increased from 24.2 ± 7.3 (range: 14.0-37.0) to 749.2 ± 497.7 (range: 26.5-1720.0) pg/mL (normal range < 8.0) (p < 0.05). These findings indicate distinct biomarker dynamics, in which tocilizumab therapy led to elevated IL-6 levels, while rituximab improved iMCD symptoms by reducing IL-6 levels.
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