Tocilizumab in the treatment of systemic-onset juvenile idiopathic arthritis - single-centre experience

Justyna Roszkiewicz, Krzysztof Orczyk, Elżbieta Smolewska, Justyna Roszkiewicz, Krzysztof Orczyk, Elżbieta Smolewska

Abstract

Objectives: The aim of the study was to evaluate the efficacy and long-term safety of tocilizumab treatment in children with systemic-onset juvenile idiopathic arthritis in a single centre.

Material and methods: The study was based on a retrospective analysis of a cohort of 10 patients with systemic-onset juvenile idiopathic arthritis who were treated with tocilizumab in the period September 2011-July 2017. Their medical records were analysed taking into consideration the effectiveness of tocilizumab treatment and frequency of side effects.

Results: Before the initiation of treatment, 9/10 patients from the study group complained of fever and had significantly increased values of inflammatory markers, with the median CRP concentration 41.1 mg/l (norm < 5 mg/l) and ESR 37 mm/h (norm < 12 mg/l). The period of the initial 12 weeks of treatment was a quantum leap in the course of the disease: all children were afebrile, and inflammatory markers values decreased by 99.4% in the case of CRP and 91.9% in ESR. All patients fulfilled ACR Pedi 50 criteria, and 3 of them achieved ACR Pedi 70. In the next stages of treatment the response to tocilizumab was sustained, reaching 10 children achieving ACR Pedi 70 and 5 ACR Pedi 90 after one year of therapy. Tocilizumab appeared to be relatively safe in the study group. Although elevation of transaminases and neutropenia were observed in 5/10 patients, they were usually mild and transitional in their course.

Conclusions: Tocilizumab is both effective and has a relatively good safety profile in children with severe systemic-onset juvenile idiopathic arthritis. It should be considered in the recommendations as a first-line treatment of this disease.

Keywords: biologic treatment effectiveness; systemic-onset juvenile idiopathic arthritis; tocilizumab; treatment response.

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Fig. 1
Fig. 1
Time courses of American College of Rheumatology Pediatric (ACR Pedi) 30, 50, and 70 responses.

References

    1. De Benedetti F, Brunner HI, Ruperto N, et al. Randomised trial of tocilizumab in systemic juvenile idiopathic arthritis. N Engl J Med. 2012;367:2385–2395.
    1. Cimaz R. Systemic-onset juvenile idiopathic arthritis. Autoimmun Rev. 2016;15:931–934.
    1. Prince FH, Twilt M, ten Cate R, et al. Long-term follow-up on effectiveness and safety of etanercept in juvenile idiopathic arthritis: the Dutch national register. Ann Rheum Dis. 2009;68:635–641.
    1. Horneff G, De Bock F, Foeldvari I, et al. Safety and efficacy of combination of etanercept and methotrexate compared to treatment with etanercept only in patients with juvenile idiopathic arthritis (JIA): preliminary data from the German JIA Registry. Ann Rheum Dis. 2009;68:519–525.
    1. Horneff G, Schulz AC, Klotsche J, et al. Experience with etanercept, tocilizumab and interleukin-1 inhibitors on systemic onset juvenile idiopathic arthritis patients from the BIKER registry. Arthritis Res Ther. 2017;19:256.
    1. Turnier JL, Brunner HI. Tocilizumab for treating juvenile idiopathic arthritis. Expert Opin Biol Ther. 2016;16:559–566.
    1. Program leczenia reumatoidalnego zapalenia stawów i młodzieńczego idiopatycznego zapalenia stawów o przebiegu agresywnym [online] 2017. [Access: 5.08.2018]. Available at: htps:// .
    1. Petty RE, Southwood TR, Manners P, et al. International league of associations for rheumatology classification of juvenile idiopathic arthritis: second revision, Edmonton, 2001. J Rheumatol. 2004;31:390–392.
    1. Wallace CA, Giannini EH, Huang H, et al. American College of Rheumatology provisional criteria for defining clinical inactive disease in select categories of juvenile idiopathic arthritis. Arthritis Care Res (Hoboken) 2011;63:929–936.
    1. Yokota S, Imagawa T, Mori M, et al. Efficacy and safety of tocilizumab in patients with systemic-onset juvenile idiopathic arthritis: a randomised, double-blind, placebo-controlled, withdrawal phase III trial. Lancet. 2008;371:998–1006.
    1. Woo P WN, Prieur AM, Southwood T, et al. Open label phase II trial of single, ascending doses of MRA in Caucasian children with severe systemic juvenile idiopathic arthritis: proof of principle of the efficacy of IL-6 receptor blockade in this type of arthritis and demonstration of prolonged clinical improvement. Arthritis Res Ther. 2005;7:R1281–1288.
    1. Yokota S, Itoh Y, Morio T, et al. Tocilizumab in systemic juvenile idiopathic arthritis in a real-world clinical setting: results from 1 year of postmarketing surveillance follow-up of 417 patients in Japan. Ann Rheum Dis. 2016;75:1654–1660.
    1. De Benedetti F, Brunner HI, Allen R, et al. The efficacy of tocilizumab in patients with systemic juvenile idiopathic arthritis: 52-week data from a phase 3 clinical trial. British Society of Rheumatology Annual Meeting; May 2012.
    1. De Benedetti F, Brunner H, Ruperto N, et al. FRI0328 Efficacy and safety of tocilizumab (TCZ) in patients with systemic juvenile idiopathic arthritis (SJIA): 2-year data from tender, a phase 3 clinical trial. Ann Rheum Dis. 2013;71:425.
    1. Horneff G. Biologic-associated infections in pediatric rheumatology. Curr Rheumatol Rep. 2015;17:66.
    1. Tarp S, Amarilyo G, Foeldvari I, et al. Efficacy and safety of biological agents for systemic juvenile idiopathic arthritis: a systemic review and meta-analysis of randomized trials. Rheumatology (Oxford) 2016;55:669–679.

Source: PubMed

Sponzoři a spolupracovníci

Zdravotní podmínky

Drogové intervence

3
Předplatit