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Haemostatic changes and bleeding with anti-IL-6 directed therapy in autoimmune diseases
Charlotte D C C van der Heijden1, Loes C Oskam2, Lenny van Bon2
1Department of Internal Medicine, Radboud University Medical Center, Nijmegen, the Netherlands.
British Journal of Pharmacology
|May 28, 2026
Summary
Tocilizumab (TCZ) therapy for autoimmune diseases can cause bleeding complications by affecting fibrinogen and platelet production. Early recognition and targeted monitoring are crucial for managing these rare but significant hemostatic disruptions.
Area of Science:
- Immunology
- Hematology
- Pharmacology
Background:
- Interleukin-6 (IL-6) is a key regulator of inflammation and hemostasis.
- Anti-IL-6 therapy, notably tocilizumab (TCZ), is used for autoimmune diseases.
- TCZ treatment is associated with rare but significant bleeding complications.
Purpose of the Study:
- To review current knowledge on hemostatic effects and bleeding complications of anti-IL-6 therapeutics.
- To detail incidence, clinical characteristics, and severity of hemostatic disruptions.
- To discuss proposed mechanisms and management strategies for bleeding complications.
Main Methods:
- Narrative review of existing literature.
- Analysis of clinical experience with anti-IL-6 therapeutics.
- Synthesis of data on hemostatic parameters and bleeding events.
Main Results:
- Bleeding complications can range from minor bruising to severe hematomas or DIC.
- Hypofibrinogenemia is common (>50% in some cohorts), often asymptomatic.
- Acquired Factor XIII (FXIII) deficiency is rare.
- Routine coagulation tests may mask underlying hemostatic abnormalities.
Conclusions:
- Anti-IL-6 therapy can disrupt IL-6-regulated hemostasis, affecting fibrinogen and potentially FXIII.
- Early recognition, targeted laboratory monitoring (e.g., fibrinogen, FXIII), and individualized management are essential.
- Vigilance for bleeding complications is crucial given the expanding use of anti-IL-6 agents.
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