Anti-Interleukin 6 Therapeutics for Chronic Antibody-Mediated Rejection in Kidney Transplant Recipients

Chronic antibody-mediated rejection is the predo-minant cause for late renal allograft loss for which there is, as yet, no treatment approved by the US Food and Drug Administration, although there are clinical trials in progress to evaluate novel treatment strategies. The current standard of care treatment is based on expert consensus, rather than scientific evidence, and includes glucocorticoids, plasma exchange, and intravenous immunoglobulin, with or without rituximab or bortezomib. The low success rate with presently established management protocols represents a conspicuous exigency in the field of kidney transplantation. This review focuses on the biologic basis for interleukin 6 inhibitors, specifically tocilizumab and clazakizumab, and the safety and efficacy profiles of these agents for treatment of chronic antibody -mediated rejection in kidney transplant recipients.

Automated summary

Chronic antibody-mediated rejection is a major cause of late renal allograft loss, with no approved treatment. Current standard treatment protocols are based on expert consensus rather than scientific evidence and have low success rates. This review focuses on the biologic basis, safety, and efficacy of interleukin 6 inhibitors, tocilizumab and clazakizumab, for treating chronic antibody-mediated rejection in kidney transplant recipients.