Interleukin-6 receptor inhibition with tocilizumab induces a selective and substantial increase in plasma IP-10 and MIP-1β in non-ST-elevation myocardial infarction

Abstract Aim To evaluate the effect of interleukin-6 inhibition with tocilizumabon the cytokine network in patients with acute non- ST-elevationmyocardial infarction (NSTEMI). Methods 117 patients with acute NSTEMI were randomised to an intravenous infusion of 280 mg tocilizumabor placebo prior to coronary angiography. Blood samples were obtained at baseline, at 6 consecutive points in time during hospitalisation, and at follow-up after 3 and 6 months. Cytokines ( n  = 27) were analysed with a multiplex cytokine assay. Results Using a mixed between-within subjects analysis of variance, we observed a significant ( p m Δ ), placebo: 3 (−60, 68) pg/ml vs tocilizumab: 209 (69, 335) pg/ml; MIP-1β m Δ , placebo: 5 (−2, 12) pg/ml vs tocilizumab: 39 (24, 63) pg/ml). MIP-1β was inversely correlated to troponin T( r  = −0.28, p r  = −0.32, p  Conclusions Tocilizumabled to a selective and substantial increase in IP-10 and MIP-1β during the acute phase of NSTEMI, with no or only minor effects on the other measured cytokines. ClinicalTrials.gov, NCT01491074.