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IL-6 has a key role in supporting immunocompetent responses to all type of infections, especially bacterial events. Agents targeting IL-6 and/or its receptor may result in severe and potentially life-threatening infections with significant discrepancy in both clinical and laboratory markers. Current evidence on the infection risk associated with the use of IL-6 or IL-6R-targeted agents consists mostly of studies including patients treated for a chronic autoimmune condition, such as rheumatoid arthritis (RA). Recently, a huge amount of data on these agents has been obtained from its use in hospitalized patients for COVID-19. The incidence of severe (secondary) infections in observational studies was higher than that observed in randomized controlled trials for both conditions. For patients with RA, such incidence seems to be similar or slightly higher than that associated with the use of other immunomodulatory drugs, in particular anti-TNF-α agents. However, a systematic active search or surveillance screening for infectious disease during or after treatment with IL-6 or IL-6R-targeted agents has not yet been performed.

DOI: 10.1007/978-3-031-11363-5_10