Castleman Disease Medication

Updated: Jul 13, 2017
  • Author: Neetu Radhakrishnan, MD; Chief Editor: Emmanuel C Besa, MD  more...
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Medication

Medication Summary

Various therapies have been used for multicentric Castleman disease (MCD), including the following:

  • Intravenous immunoglobulin (IVIG)
  • Antivirals that target human herpesvirus–8 (HHV-8),
  • Angiogenesis inhibitors (eg, thalidomide)
  • Corticosteroids for inflammation
  • Chemotherapy
  • Agents that decrease interleukin-6 (IL-6).

Siltuximab (Sylvant) is the only biologic approved by the US Food and Drug Administration (FDA) for MCD. [22] Siltuximab is a monoclonal antibody that binds IL-6. Other drugs with anti-IL-6 actions that are used off-label include tocilizumab and rituximab. Tocilizumab is an IL-6 antagonist, while rituximab targets CD20 and affects IL-6 production.

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Immunomodulators

Class Summary

Agents that decrease IL-6 production or actions are emerging for MCD.

Siltuximab (Sylvant)

Siltuximab is a monoclonal antibody that binds IL-6 and prevents the binding of IL-6 to both soluble and membrane-bound IL-6 receptors. It is approved by the FDA with an indication for multicentric Castleman disease in patients who are negative for HIV and human herpesvirus-8.

Tocilizumab (Actemra)

Tocilizumab is an IL-6 receptor antagonist. It has been used off-label for multicentric Castleman disease.

Rituximab (Rituxan)

Rituximab is a humanized monoclonal antibody that binds to CD20 antigen, which results in decreased IL-6 production. It has been used off-label for multicentric Castleman disease.

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