Summary

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• Sylvant (siltuximab) is indicated for the treatment of patients with multicentric Castleman’s disease (MCD) who are HIV-negative and HHV-8 negative.
• This summary is based on the review of two systematic review(s)/meta-analysis(es). ^[1-2]
• Multicentric Castleman Disease (MCD) and Idiopathic MCD (iMCD): Siltuximab has shown efficacy and long-term safety in treating iMCD, although the response rate is reported to be less than 50%. Thalidomide demonstrated high response rates in iMCD patients, and bortezomib showed effectiveness in relapsed/refractory MCD.
• HHV8-Associated MCD: Rituximab combined with doxorubicin, followed by zidovudine and valganciclovir, is identified as the most effective therapy. Tocilizumab showed potential efficacy in a single-arm trial.
• Various Inflammatory Diseases: Siltuximab has expanded therapeutic use in neuromyelitis optica, and other IL-6 inhibitors, like tocilizumab, are effective in conditions such as rheumatoid arthritis, juvenile idiopathic arthritis, and advanced COVID-19.
• Siltuximab: Demonstrated long-term safety in treating idiopathic multicentric Castleman disease (iMCD), with a safety profile similar to other biological disease-modifying antirheumatic drugs (bDMARDs) targeting IL-6.
• Other IL-6 Inhibitors (e.g., Tocilizumab): Comparable safety outcomes to other bDMARDs, but with noted higher risks for diverticulitis and lower gastrointestinal perforations, and inconsistent findings regarding infection risk compared to TNF-inhibitors.
• There is no population types or subgroups information available in the reviewed studies.