Summary

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• This summary is based on the review of two systematic review(s)/meta-analysis(es). ^[1-2]
• Siltuximab is effective in idiopathic multicentric Castleman disease (iMCD), although the response rate remains below 50%, indicating limited efficacy for a subset of patients. Additionally, siltuximab and other IL-6 inhibitors demonstrate beneficial effects in several inflammatory diseases, including rheumatoid arthritis, juvenile idiopathic arthritis, giant cell arteritis, Takayasu arteritis, adult-onset Still's disease, cytokine release syndrome, and systemic sclerosis-associated interstitial lung disease.
• Comparative Effectiveness: Siltuximab has shown efficacy in iMCD, but alternatives like thalidomide have reported higher response rates in iMCD patients. In HHV8 (human herpesvirus-8)-associated MCD, a rituximab-based regimen with doxorubicin, zidovudine, and valganciclovir is the most effective treatment, whereas tocilizumab is particularly effective for advanced COVID-19 cases. Siltuximab demonstrates a safety profile comparable to other biological disease-modifying antirheumatic drugs (bDMARDs), although specific adverse effects for siltuximab were not detailed in the studies.
• Tocilizumab is associated with increased risks of diverticulitis and lower gastrointestinal perforations, with inconsistent findings regarding infection risks compared to TNF-inhibitors. Siltuximab is FDA-approved for idiopathic multicentric Castleman disease (iMCD) but has a response rate of less than 50%, indicating the need for alternative or supplementary treatments in this population. In contrast, rituximab-based therapy combined with doxorubicin, zidovudine, and valganciclovir is considered most effective for human herpesvirus-8-associated MCD (HHV8-MCD), while tocilizumab has shown efficacy specifically in advanced COVID-19 cases.