Pub Date : 2024-06-01DOI: 10.1136/conmed-2024-000010
Brian P Halliday, Fozia Z Ahmed, Janine Beezer, Ahmet Fuat, Andrew J Ludman, P. Pellicori, Henry Oluwasefunmi Savage, Clare J Taylor, John G. F. Cleland
The current treatment landscape for heart failure is predominantly stratified using ejection fraction. Established drug combinations and devices such as cardiac resynchronisation therapy are available for heart failure with reduced ejection fraction (HFrEF), but medical options for heart failure with preserved ejection fraction (HFpEF) have, until recently, been lacking. A major advance in recent years has been the discovery of effective therapies for HFpEF, including sodium-glucose co-transporter 2 (SGLT2) inhibitors and perhaps also the mineralocorticoid receptor antagonist, spironolactone. For patients with atrial fibrillation and heart failure, the benefit of rhythm control with either radiofrequency ablation or medical therapy is uncertain. Targeted therapies for the small proportion of patients with transthyretin cardiac amyloidosis are available, while antifibrotics seem promising for a larger proportion of patients. For patients with HFrEF, additional treatment options have emerged in the past 10 years. The angiotensin receptor–neprilysin inhibitor (ARNI) combination sacubitril–valsartan and SGLT-2 inhibitors reduce mortality and improve life expectancy in symptomatic patients with HFrEF and at least mildly elevated plasma concentrations of N-terminal pro-brain natriuretic peptide (NT-proBNP). The oral soluble guanylate cyclase stimulator vericiguat and cardiac myosin activator omecamtiv mecarbil are not yet licensed in the UK but may provide further treatment options, perhaps in more select groups of patients. Whether all patients with a prior diagnosis of HFrEF who are now in heart failure remission should continue all therapies at maximum tolerated dose indefinitely remains a dilemma. Individualised de-escalation of therapy remains controversial due to the risk of relapse but is occasionally trialled, particularly in patients with a triggering factor such as pregnancy. The ultimate aim is a personalised treatment plan—based on disease phenotype and trajectory—that minimises the risk of relapse and maximises the individual’s quality of life.
{"title":"Evolutions in care, unmet needs, and research priorities in heart failure","authors":"Brian P Halliday, Fozia Z Ahmed, Janine Beezer, Ahmet Fuat, Andrew J Ludman, P. Pellicori, Henry Oluwasefunmi Savage, Clare J Taylor, John G. F. Cleland","doi":"10.1136/conmed-2024-000010","DOIUrl":"https://doi.org/10.1136/conmed-2024-000010","url":null,"abstract":"The current treatment landscape for heart failure is predominantly stratified using ejection fraction. Established drug combinations and devices such as cardiac resynchronisation therapy are available for heart failure with reduced ejection fraction (HFrEF), but medical options for heart failure with preserved ejection fraction (HFpEF) have, until recently, been lacking. A major advance in recent years has been the discovery of effective therapies for HFpEF, including sodium-glucose co-transporter 2 (SGLT2) inhibitors and perhaps also the mineralocorticoid receptor antagonist, spironolactone. For patients with atrial fibrillation and heart failure, the benefit of rhythm control with either radiofrequency ablation or medical therapy is uncertain. Targeted therapies for the small proportion of patients with transthyretin cardiac amyloidosis are available, while antifibrotics seem promising for a larger proportion of patients. For patients with HFrEF, additional treatment options have emerged in the past 10 years. The angiotensin receptor–neprilysin inhibitor (ARNI) combination sacubitril–valsartan and SGLT-2 inhibitors reduce mortality and improve life expectancy in symptomatic patients with HFrEF and at least mildly elevated plasma concentrations of N-terminal pro-brain natriuretic peptide (NT-proBNP). The oral soluble guanylate cyclase stimulator vericiguat and cardiac myosin activator omecamtiv mecarbil are not yet licensed in the UK but may provide further treatment options, perhaps in more select groups of patients. Whether all patients with a prior diagnosis of HFrEF who are now in heart failure remission should continue all therapies at maximum tolerated dose indefinitely remains a dilemma. Individualised de-escalation of therapy remains controversial due to the risk of relapse but is occasionally trialled, particularly in patients with a triggering factor such as pregnancy. The ultimate aim is a personalised treatment plan—based on disease phenotype and trajectory—that minimises the risk of relapse and maximises the individual’s quality of life.","PeriodicalId":356175,"journal":{"name":"Considerations in Medicine","volume":"12 20","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141393874","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-01DOI: 10.1136/conmed-2024-000008
P. Pellicori, Fozia Z Ahmed, Janine Beezer, Ahmet Fuat, Brian P Halliday, Andrew J Ludman, Henry Oluwasefunmi Savage, Clare J Taylor, J. G. Cleland
Timely diagnosis of heart failure leads to anticipated introduction of effective treatments, improved quality of life, and better outcomes. However, for many patients, diagnosis of heart failure is still made too late for a variety of reasons, including the heterogeneity and lack of specificity of its signs and symptoms, the absence of universally accepted diagnostic criteria and limited access to specialist care. Implementing and potentially expanding the use of natriuretic peptide testing for individuals at high risk can aid identification of preclinical cardiac dysfunction amenable to treatment, delay progression of disease or refute a heart failure diagnosis in equivocal cases. In addition, greater public awareness of the signs and symptoms of heart failure and how it differs from other cardiovascular diseases may lead affected individuals to seek prompt medical attention. Improving early diagnosis and treatment relies on bringing heart failure to the fore in both the public arena and the clinic.
{"title":"Diagnosis and initial management of heart failure","authors":"P. Pellicori, Fozia Z Ahmed, Janine Beezer, Ahmet Fuat, Brian P Halliday, Andrew J Ludman, Henry Oluwasefunmi Savage, Clare J Taylor, J. G. Cleland","doi":"10.1136/conmed-2024-000008","DOIUrl":"https://doi.org/10.1136/conmed-2024-000008","url":null,"abstract":"Timely diagnosis of heart failure leads to anticipated introduction of effective treatments, improved quality of life, and better outcomes. However, for many patients, diagnosis of heart failure is still made too late for a variety of reasons, including the heterogeneity and lack of specificity of its signs and symptoms, the absence of universally accepted diagnostic criteria and limited access to specialist care. Implementing and potentially expanding the use of natriuretic peptide testing for individuals at high risk can aid identification of preclinical cardiac dysfunction amenable to treatment, delay progression of disease or refute a heart failure diagnosis in equivocal cases. In addition, greater public awareness of the signs and symptoms of heart failure and how it differs from other cardiovascular diseases may lead affected individuals to seek prompt medical attention. Improving early diagnosis and treatment relies on bringing heart failure to the fore in both the public arena and the clinic.","PeriodicalId":356175,"journal":{"name":"Considerations in Medicine","volume":"88 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141405600","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-01DOI: 10.1136/conmed-2024-000007
Clare J Taylor, Janine Beezer, Ahmet Fuat, Brian P Halliday, Andrew J Ludman, P. Pellicori, Henry Oluwasefunmi Savage, John G. F. Cleland
Current guidelines for the treatment of heart failure do not focus on its prevention despite the steady global rise in prevalence. A new framework is needed to help clinicians routinely and efficiently identify patients at high risk of heart failure based on family history and risk factors, including obesity, hypertension, and diabetes mellitus. At present, guidelines recommend lifestyle changes, healthy diet, physical activity, antihypertensive treatment, cholesterol-lowering agents, and sodium-glucose co-transporter two inhibitor treatment to address risk factors for heart failure. However, in recent years, outcomes for patients with a diagnosis of heart failure have stagnated, highlighting the need for earlier implementation of better prevention strategies. Updated guidelines must include a roadmap that specifies who should intervene and at what point in the care cycle, to give patients the best possible chance at avoiding or delaying heart failure. A combination of public awareness campaigns, education for healthcare professionals, and improved screening methods is needed to aid the prediction and, crucially, prevention of heart failure.
{"title":"Predicting and preventing heart failure","authors":"Clare J Taylor, Janine Beezer, Ahmet Fuat, Brian P Halliday, Andrew J Ludman, P. Pellicori, Henry Oluwasefunmi Savage, John G. F. Cleland","doi":"10.1136/conmed-2024-000007","DOIUrl":"https://doi.org/10.1136/conmed-2024-000007","url":null,"abstract":"Current guidelines for the treatment of heart failure do not focus on its prevention despite the steady global rise in prevalence. A new framework is needed to help clinicians routinely and efficiently identify patients at high risk of heart failure based on family history and risk factors, including obesity, hypertension, and diabetes mellitus. At present, guidelines recommend lifestyle changes, healthy diet, physical activity, antihypertensive treatment, cholesterol-lowering agents, and sodium-glucose co-transporter two inhibitor treatment to address risk factors for heart failure. However, in recent years, outcomes for patients with a diagnosis of heart failure have stagnated, highlighting the need for earlier implementation of better prevention strategies. Updated guidelines must include a roadmap that specifies who should intervene and at what point in the care cycle, to give patients the best possible chance at avoiding or delaying heart failure. A combination of public awareness campaigns, education for healthcare professionals, and improved screening methods is needed to aid the prediction and, crucially, prevention of heart failure.","PeriodicalId":356175,"journal":{"name":"Considerations in Medicine","volume":"66 S1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141404934","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-11-01DOI: 10.1136/conmed-2018-000004
E. Choy, Simon A. Jones, D. Aletaha, T. Takeuchi, I. McInnes, J. Smolen
Interleukin (IL)−6 inhibition has been approved for the treatment of rheumatoid arthritis, systemic juvenile arthritis, polyarticular juvenile idiopathic arthritis, giant cell arteritis, and, in some countries, Castleman’s disease. IL-6 has also been implicated in several non-rheumatoid arthritis inflammatory and immune conditions such as systemic sclerosis, vasculitides, systemic lupus erythematous, and psoriatic arthritis. In orphan diseases, such as systemic sclerosis, which are associated with significant morbidity and mortality and for which there are no approved treatments, IL-6 inhibition may offer a promising treatment strategy. It is also becoming clear that IL-6 may have an important role not only in inflammatory and immune diseases but also in non-immune mediated diseases such as endogenous depression and depression associated with chronic inflammatory conditions. Several studies have explored the effect of IL-6 pathway inhibition in Crohn’s disease and adult-onset Still’s disease, suggesting that IL-6 may be important in their pathogenesis.
{"title":"IL-6: To immunity and beyond","authors":"E. Choy, Simon A. Jones, D. Aletaha, T. Takeuchi, I. McInnes, J. Smolen","doi":"10.1136/conmed-2018-000004","DOIUrl":"https://doi.org/10.1136/conmed-2018-000004","url":null,"abstract":"Interleukin (IL)−6 inhibition has been approved for the treatment of rheumatoid arthritis, systemic juvenile arthritis, polyarticular juvenile idiopathic arthritis, giant cell arteritis, and, in some countries, Castleman’s disease. IL-6 has also been implicated in several non-rheumatoid arthritis inflammatory and immune conditions such as systemic sclerosis, vasculitides, systemic lupus erythematous, and psoriatic arthritis. In orphan diseases, such as systemic sclerosis, which are associated with significant morbidity and mortality and for which there are no approved treatments, IL-6 inhibition may offer a promising treatment strategy. It is also becoming clear that IL-6 may have an important role not only in inflammatory and immune diseases but also in non-immune mediated diseases such as endogenous depression and depression associated with chronic inflammatory conditions. Several studies have explored the effect of IL-6 pathway inhibition in Crohn’s disease and adult-onset Still’s disease, suggesting that IL-6 may be important in their pathogenesis.","PeriodicalId":356175,"journal":{"name":"Considerations in Medicine","volume":"38 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"117127496","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-11-01DOI: 10.1136/conmed-2018-000003
J. Smolen, D. Aletaha, E. Choy, Simon A. Jones, T. Takeuchi, I. McInnes
Compounds that target interleukin (IL)−6 pathways include antibodies against the IL-6 receptor or ligand, and inhibitors of IL-6 signal transduction. The anti-IL-6 receptor (IL-6R) monoclonal antibody tocilizumab has been licensed for several years; data from multiple studies demonstrate its efficacy and tolerability in rheumatoid arthritis as monotherapy or in combination with methotrexate. In addition, another anti-IL-6R monoclonal antibody, sarilumab, has recently been approved in both the US and EU. Anti-IL-6 monoclonal antibodies include olokizumab and clazakizumab, which both have data from phase II studies, as well as sirukumab which has completed phase III trials but may not be brought to the market. Comparative data for olokizumab versus tocilizumab intervention in rheumatoid arthritis suggest no difference in efficacy between blocking the receptor or the ligand. Head-to-head studies are needed to determine whether inhibition of the Janus kinase pathway is similar in its overall efficacy to direct inhibition of IL-6 or its receptor. The IL-6 inhibitors appear to be more effective when combined with methotrexate. However, they have shown superiority to tumour necrosis factor inhibitors when used as monotherapy, and may have an advantage in patients who cannot use methotrexate or any other conventional synthetic disease modifying anti-rheumatic drug. Regarding disease activity assessment, CDAI is a more appropriate measure than DAS28 when looking at the effect of IL-6 inhibition, as these agents interfere with the acute phase response, which is heavily weighted in the formula of DAS28.
{"title":"Targeting IL-6: A review of data","authors":"J. Smolen, D. Aletaha, E. Choy, Simon A. Jones, T. Takeuchi, I. McInnes","doi":"10.1136/conmed-2018-000003","DOIUrl":"https://doi.org/10.1136/conmed-2018-000003","url":null,"abstract":"Compounds that target interleukin (IL)−6 pathways include antibodies against the IL-6 receptor or ligand, and inhibitors of IL-6 signal transduction. The anti-IL-6 receptor (IL-6R) monoclonal antibody tocilizumab has been licensed for several years; data from multiple studies demonstrate its efficacy and tolerability in rheumatoid arthritis as monotherapy or in combination with methotrexate. In addition, another anti-IL-6R monoclonal antibody, sarilumab, has recently been approved in both the US and EU. Anti-IL-6 monoclonal antibodies include olokizumab and clazakizumab, which both have data from phase II studies, as well as sirukumab which has completed phase III trials but may not be brought to the market. Comparative data for olokizumab versus tocilizumab intervention in rheumatoid arthritis suggest no difference in efficacy between blocking the receptor or the ligand. Head-to-head studies are needed to determine whether inhibition of the Janus kinase pathway is similar in its overall efficacy to direct inhibition of IL-6 or its receptor. The IL-6 inhibitors appear to be more effective when combined with methotrexate. However, they have shown superiority to tumour necrosis factor inhibitors when used as monotherapy, and may have an advantage in patients who cannot use methotrexate or any other conventional synthetic disease modifying anti-rheumatic drug. Regarding disease activity assessment, CDAI is a more appropriate measure than DAS28 when looking at the effect of IL-6 inhibition, as these agents interfere with the acute phase response, which is heavily weighted in the formula of DAS28.","PeriodicalId":356175,"journal":{"name":"Considerations in Medicine","volume":"103 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127640575","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-11-01DOI: 10.1136/conmed-2018-000002
T. Takeuchi, J. Smolen, E. Choy, D. Aletaha, I. McInnes, Simon A. Jones
Interleukin (IL)−6 represents one of several possible targets for the treatment of rheumatoid arthritis. Drugs targeting IL-6 can be divided into monoclonal antibodies against IL-6 itself and monoclonal antibodies against the IL-6 receptor. Both types of agent inhibit both classical signalling through membrane-bound IL-6 receptor, and trans-signalling via formation of a complex between IL-6 and soluble IL-6 receptor. The IL-6 receptor blockers tocilizumab and sarilumab inhibit the low affinity binding of IL-6 to its receptor. The anti-IL-6 agents clazakizumab and vobarilizumab also block binding of IL-6 to the receptor, while olokizumab blocks the higher affinity interaction of the IL-6-receptor complex with gp130. The doses and dosing intervals of the biologics targeting different elements vary, but no major differences in efficacy or safety have yet been seen between the two approaches, although more studies are needed in this area. In addition to the different blocking actions of monoclonal antibodies, we consider therapeutic strategies including the timing of IL-6 blockade and the use of monotherapy versus the addition of methotrexate.
{"title":"Considering new lessons about the use of IL-6 inhibitors in arthritis","authors":"T. Takeuchi, J. Smolen, E. Choy, D. Aletaha, I. McInnes, Simon A. Jones","doi":"10.1136/conmed-2018-000002","DOIUrl":"https://doi.org/10.1136/conmed-2018-000002","url":null,"abstract":"Interleukin (IL)−6 represents one of several possible targets for the treatment of rheumatoid arthritis. Drugs targeting IL-6 can be divided into monoclonal antibodies against IL-6 itself and monoclonal antibodies against the IL-6 receptor. Both types of agent inhibit both classical signalling through membrane-bound IL-6 receptor, and trans-signalling via formation of a complex between IL-6 and soluble IL-6 receptor. The IL-6 receptor blockers tocilizumab and sarilumab inhibit the low affinity binding of IL-6 to its receptor. The anti-IL-6 agents clazakizumab and vobarilizumab also block binding of IL-6 to the receptor, while olokizumab blocks the higher affinity interaction of the IL-6-receptor complex with gp130. The doses and dosing intervals of the biologics targeting different elements vary, but no major differences in efficacy or safety have yet been seen between the two approaches, although more studies are needed in this area. In addition to the different blocking actions of monoclonal antibodies, we consider therapeutic strategies including the timing of IL-6 blockade and the use of monotherapy versus the addition of methotrexate.","PeriodicalId":356175,"journal":{"name":"Considerations in Medicine","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130341717","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-11-01DOI: 10.1136/CONMED-2018-000006
I. McInnes
Targeting interleukin (IL)−6 or its receptor for the treatment of inflammatory disease is an attractive approach to the management of complex inflammatory diseases, especially those with a systemic component to their presentation and comorbidity. Biological drugs that target IL-6 receptor are already in clinical practice. Recently, more agents are emerging from clinical trials that block distinct parts of the IL-6/IL-6R pathway. In this edition, Jones et al explore the rich diversity of biology mediated by IL-6. …
{"title":"Considering IL-6","authors":"I. McInnes","doi":"10.1136/CONMED-2018-000006","DOIUrl":"https://doi.org/10.1136/CONMED-2018-000006","url":null,"abstract":"Targeting interleukin (IL)−6 or its receptor for the treatment of inflammatory disease is an attractive approach to the management of complex inflammatory diseases, especially those with a systemic component to their presentation and comorbidity. Biological drugs that target IL-6 receptor are already in clinical practice. Recently, more agents are emerging from clinical trials that block distinct parts of the IL-6/IL-6R pathway.\u0000\u0000In this edition, Jones et al explore the rich diversity of biology mediated by IL-6. …","PeriodicalId":356175,"journal":{"name":"Considerations in Medicine","volume":"19 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132366293","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-11-01DOI: 10.1136/conmed-2018-000005
Simon A. Jones, T. Takeuchi, D. Aletaha, J. Smolen, E. Choy, I. McInnes
The cytokine interleukin (IL)−6 performs a diverse portfolio of functions in normal physiology and disease. These functions extend beyond the typical role for an inflammatory cytokine, and IL-6 often displays hormone-like properties that affect metabolic processes associated with lipid metabolism, insulin resistance, and the neuroendocrine system. Consequently, the biology of IL-6 is complex. Recent advances in the field have led to novel interpretations of how IL-6 delivers immune homeostasis in health and yet drives disease pathology during infection, autoimmunity, and cancer. Various biological drugs that target IL-6 are in clinical practice or emerging in clinical trials and pre-clinical development programmes. The challenge is knowing how and when to apply these therapies. In this review, we will explore the biology behind IL-6 directed therapies and identify some key hurdles for future investigation.
{"title":"Interleukin 6: The biology behind the therapy","authors":"Simon A. Jones, T. Takeuchi, D. Aletaha, J. Smolen, E. Choy, I. McInnes","doi":"10.1136/conmed-2018-000005","DOIUrl":"https://doi.org/10.1136/conmed-2018-000005","url":null,"abstract":"The cytokine interleukin (IL)−6 performs a diverse portfolio of functions in normal physiology and disease. These functions extend beyond the typical role for an inflammatory cytokine, and IL-6 often displays hormone-like properties that affect metabolic processes associated with lipid metabolism, insulin resistance, and the neuroendocrine system. Consequently, the biology of IL-6 is complex. Recent advances in the field have led to novel interpretations of how IL-6 delivers immune homeostasis in health and yet drives disease pathology during infection, autoimmunity, and cancer. Various biological drugs that target IL-6 are in clinical practice or emerging in clinical trials and pre-clinical development programmes. The challenge is knowing how and when to apply these therapies. In this review, we will explore the biology behind IL-6 directed therapies and identify some key hurdles for future investigation.","PeriodicalId":356175,"journal":{"name":"Considerations in Medicine","volume":"21 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134286556","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-10-30DOI: 10.1136/conmed-2017-100001eb
I. McInnes
### To consider (verb) – Oxford English dictionary As clinicians, every day we face decisions requiring us to consider our options based upon the best available data. Whether this is selecting the right medicine for a patient’s condition or understanding a …
{"title":"Considerations in Medicine","authors":"I. McInnes","doi":"10.1136/conmed-2017-100001eb","DOIUrl":"https://doi.org/10.1136/conmed-2017-100001eb","url":null,"abstract":"### To consider (verb) – Oxford English dictionary \u0000\u0000As clinicians, every day we face decisions requiring us to consider our options based upon the best available data. Whether this is selecting the right medicine for a patient’s condition or understanding a …","PeriodicalId":356175,"journal":{"name":"Considerations in Medicine","volume":"7 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2017-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126885502","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：