Next Article in Journal
Antiviral Agents in Development for Zika Virus Infections
Previous Article in Journal
Psychotropic Drugs for the Management of Chronic Pain and Itch
Previous Article in Special Issue
Ferritin in Kidney and Vascular Related Diseases: Novel Roles for an Old Player
Article Menu

Export Article

Version is current.

Open AccessArticle

Changes in Iron Metabolism Induced by Anti-Interleukin-6 Receptor Monoclonal Antibody are Associated with an Increased Risk of Infection

Immune Response and Vascular Disease—CEDOC, Chronic Diseases Research Center, NOVA Medical School, 1150-082 Lisbon, Portugal
Systemic Immune-mediated Diseases Unit (UDIMS), Department of Medicine IV, Hospital Professor Doutor Fernando Fonseca, 2720-276 Amadora, Portugal
Author to whom correspondence should be addressed.
Pharmaceuticals 2019, 12(3), 100;
Received: 1 June 2019 / Revised: 20 June 2019 / Accepted: 25 June 2019 / Published: 28 June 2019
(This article belongs to the Special Issue Iron as Therapeutic Targets in Human Diseases)
PDF [3309 KB, uploaded 28 June 2019]


(1) Background: Treatment of patients with rheumatoid arthritis (RA) with an anti-IL-6 receptor (anti-IL-6R) monoclonal antibody (tocilizumab) has been found to influence iron metabolism. The objective of the present study was to ascertain whether changes in iron metabolism induced by anti-IL-6R biologic therapy were independently associated with an increased infection risk. (2) Methods: A prospective longitudinal study of patients with RA treated with tocilizumab was conducted. RA patients treated with an antitumor necrosis factor α monoclonal antibody were also included as a control group. The primary outcome was occurrence of infection during the first 24 months of biologic therapy. (3) Results: A total of 15 patients were included, with a mean age of 51.0 ± 4,1 and 73.3% (n = 11) female. A multivariate survival regression model, adjusted for confounding factors, was fitted for each of the iron metabolism variables. Hazard ratios for being above the median of each parameter was considered. Transferrin saturation above the median value (>32.1%) was associated with a higher infection risk (HR 4.3; 95%CI 1.0–19.69; p = 0.05). Similarly, although non-significantly, higher serum iron was strongly associated with infection occurrence. (4) Conclusions: This study identified a probable association between infection risk and higher serum iron and transferrin saturation in patients with RA on anti-IL-6R biologic therapy. We suggest that both these parameters should be considered relevant contributing factors for infection occurrence in patients on anti-IL-6R therapy. View Full-Text
Keywords: iron; hepcidin; ferroportin; Interleukin-6; infection; rheumatoid arthritis iron; hepcidin; ferroportin; Interleukin-6; infection; rheumatoid arthritis

Figure 1

This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited (CC BY 4.0).

Share & Cite This Article

MDPI and ACS Style

Ribeiro, R.; Batista, F.; Seguro Paula, F.; Delgado Alves, J. Changes in Iron Metabolism Induced by Anti-Interleukin-6 Receptor Monoclonal Antibody are Associated with an Increased Risk of Infection. Pharmaceuticals 2019, 12, 100.

Show more citation formats Show less citations formats

Note that from the first issue of 2016, MDPI journals use article numbers instead of page numbers. See further details here.

Related Articles

Article Metrics

Article Access Statistics



[Return to top]
Pharmaceuticals EISSN 1424-8247 Published by MDPI AG, Basel, Switzerland RSS E-Mail Table of Contents Alert
Back to Top