Successful treatment with tocilizumab every 4?weeks of a low disease activity group who achieve a drug-free remission in patients with systemic-onset juvenile idiopathic arthritis
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- 作者：Mikhail M Kostik (1)
Margarita F Dubko (1)
Vera V Masalova (1)
Ludmila S Snegireva (1)
Tatyana L Kornishina (1)
Irina A Chikova (1)
Eugenia A Isupova (1)
Ekaterina M Kuchinskaya (1)
Natalia I Glebova (1)
Natalia V Buchinskaya (1)
Olga V Kalashnikova (1)
Vyacheslav G Chasnyk (1)
1. Hospital Pediatric Department ; Saint-Petersburg State Pediatric Medical University ; Lytovskaya 2 ; Saint-Petersburg ; 194100 ; Russia - 关键词：Systemic ; onset juvenile idiopathic arthritis ; Interleukine ; 6 ; Tocilizumab ; Biologic free remission ; Low disease activity ; High disease activity
- 刊名：Pediatric Rheumatology
- 出版年：2015
- 出版时间：December 2015
- 年：2015
- 卷：13
- 期：1
- 全文大小：63 KB
- 参考文献：1. Martini A: Systemic juvenile idiopathic arthritis. / Autoimmun Rev 2012, 12:56-. 10.1016/j.autrev.2012.07.022 CrossRef
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5. Yokota S, Imagawa T, Mori M, Miyamae T, Aihara Y, Takei S, / et al.: Efficacy and safety of tocilizumab in patients with systemic-onset juvenile idiopathic arthritis: a randomized, double-blind, placebo-controlled, withdrawal phase III trial. / Lancet 2008, 371:998-006. 10.1016/S0140-6736(08)60454-7 CrossRef
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7. Pascual V, Allantaz F, Arce E, Punaro M, Banchereau J: Role of interleukin-1 (IL-1) in the pathogenesis of systemic onset juvenile idiopathic arthritis and clinical response to IL-1blockade. / J Exp Med 2005, 201:1479-6. 10.1084/jem.20050473 m.20050473" target="_blank" title="It opens in new window">CrossRef
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11. Woo P, Wilkinson N, Prieur AM, Southwood T, Leone V, Livermore P, / et al.: Open label phase II trial of single, ascending doses of MRA in Caucasianchildren 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-. 10.1186/ar1826 CrossRef
12. Maini RN, Taylor PC, Szechinski J, Pavelka K, Br?ll J, Balint G, / et al.: Double-blind randomized controlled clinical trial of the interleukin-6 receptor antagonist, tocilizumab, in European patients with rheumatoid arthritis who had an incomplete response to methotrexate. / Arth - 刊物主题：Pediatrics; Rheumatology;
- 出版者：BioMed Central
- ISSN：1546-0096
文摘
Background Systemic juvenile idiopathic arthritis (SoJIA) is the most striking form of juvenile idiopathic arthritis. The aim of our study was to evaluate the clinical responses and outcomes of children with SoJIA to IL-6 blockade using two different tocilizumab (TCZ) treatment protocols designed for milder and more severe SoJIA patient groups, and evaluate the possibility of achieving biologic-free remission. Methods Thirty-seven active SoJIA children who have failed treatment with corticosteroids and other DMARDs were included in our retrospective study. TCZ doses were prescribed in two treatment approaches: every 2?weeks TCZ dosing (Q2W) and every 4?weeks TCZ dosing (Q4W). The patients were assigned to these two groups by the study physicians depending on the severity of the SoJIA disease as judged by each clinician. Results Thirty-three of the 37 children successfully completed the trial. TCZ was discontinued in 11patients during the trial. Seven children achieved inactive disease and were allowed to stop the TCZ and 4 had severe adverse events requiring drug cessation. Currently 7 patients continue to have TCZ-free remission [4/7 remission off-medication, 3/7still on methotrexate (MTX)]. This mixed group had a median treatment duration of 1002?days. The children in remission off of all medications, TCZ and MTX, had a median remission duration of 1162?days (ranged 932-301 days). Compared to the patients assigned to the Q2W TCZ treatment group, the patients assigned to the Q4W TCZ group had a milder SoJIA course. The patients had higher levels of hemoglobin, total proteins, and serum albumins. They had lower white blood cell counts (WBC), % granulocytes, CRP, ESR, ferritins, and LDH. These children had a lower frequency of internal organ involvement, fewer relapses during TCZ treatment, and no macrophage activation syndrome episodes. Conclusions Our experience with TCZ for SoJIA supports the excellent result of other studies. What may be novel is our finding that thisIL-6 blockade with TCZ may be able to be utilized at a less frequent dosing schedule in mild SoJIA compared to severe SoJIA. We discuss other factors that may increase the probability of a patient reaching TCZ-free remission.