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Tocilizumab shown to induce remission in certain patients with systemic JIA
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A subset of patients with systemic juvenile idiopathic arthritis achieved remission after treatment with tocilizumab every 4 weeks, according to findings from a recently published retrospective Russian study; however, one patient died after developing macrophage activation syndrome.
Although some studies show tocilizumab masks the symptoms of macrophage activation syndrome, others do not.
Researchers studied 37 patients with active systemic juvenile idiopathic arthritis (sJIA) who failed prior treatment with corticosteroids and other disease-modifying anti-rheumatic drugs. Children included in the study had a mean age of 10.2 years, and mean disease duration was 36 months. Macrophage activation syndrome (MAS) was present in 12 children prior to treatment.
The researchers established two treatment groups based on the patients’ disease severity as determined by levels of hemoglobin, total proteins and serum albumen. Dosage in both groups was 12 mg/kg of tocilizumab if the child’s weight was above 30 kg or 8 mg/kg of tocilizumab if the child’s weight was below 30 kg. Patients in the high disease activity group were treated every 2 weeks, whereas patients in the low disease activity group were treated every 4 weeks. Some patients were moved from one treatment group to another during the period studied based on disease activity and response.
Thirty-three patients completed the study; three withdrew to serious adverse events and one died. Twenty-six patients who exhibited no signs of disease flare, symptom exacerbation, side effects or inefficacy were included in further treatment after the initial treatment.
Primary outcomes were defined by the number of joints with active symptoms, the number of joints with limited range of motion, physician’s global assessment of disease activity, parent’s global assessment of overall well-being and physical function using the Disability Index of the Childhood Health Assessment Questionnaire, and erythrocyte sedimentation rate.
Inactive disease was achieved in 12 patients and treatment was discontinued. All patients who achieved remission began treatment in the lower disease activity group; none in the higher disease activity group achieved remission, according to the researchers.
No new cases of MAS were seen in the lower disease activity group, and a lower frequency of organ involvement or relapse was seen in the lower disease activity group. Corticosteroids and methotrexate were also discontinued earlier in the group with lower disease activity compared with the higher disease activity group.
At the time of publication, the authors reported that seven patients maintained remission status without additional tocilizumab therapy, three of whom continued treatment with methotrexate after a median treatment duration of 1,002 days. – by Shirley Pulawski
Reference:
Shimizu M, et al. Cytokine. 2012;doi:10.1016/j.cyto.2012.02.006.
Disclosures: The authors report no relevant financial disclosures.
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