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Anakinra, tocilizumab both effective against systemic juvenile idiopathic arthritis

14 Sep 2018

Treatment with either anakinra or tocilizumab results in minimal disease activity in a significant number of patients with systemic juvenile idiopathic arthritis (JIA), a recent study has shown. Response to treatment appears to be similar despite better adherence observed with tocilizumab.

The study included 76 systemic JIA patients, among whom 54 were on tocilizumab and 22 on anakinra. Outcomes evaluated included minimal disease activity, clinically inactive disease and 90 percent ACR Paediatric response (ACRPedi90) at 1 year.

Significantly more patients started anakinra vs tocilizumab as their first biologic treatment (86 percent vs 63 percent; p=0.04). Those in the anakinra group were more likely to have shorter disease duration (1 vs 2 years; p=0.003) and prior macrophage activation syndrome (MAS; 37 percent vs 8 percent; p=0.004).

In the entire cohort, at 1 year, 42 percent of patients achieved ACRPedi90, 51 percent minimal disease activity and 39 percent clinically inactive disease. Responses were similar between the anakinra and tocilizumab groups. Response showed no association with baseline disease characteristics.

A total of 15 patients (20 percent) withdrew biologic treatment by 1 year. Treatment survival was better with tocilizumab (89 percent vs 59 percent; p=0.002), with three patients on anakinra discontinuing treatment due to injection-related problems.

Anakinra is currently recommended in the first-line treatment of patients with active MAS, as it may help recovery. In the study cohort, however, only five of the 19 patients starting anakinra as a first-line biologic had a reported history of MAS.

The finding of anakinra being used first-line in some patients, despite the availability of tocilizumab, potentially reflects clinician preference and therefore warrants further exploration, researchers said. This may have important implications with regard to informing future treatment guidelines for systemic JIA.

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Most Read Articles
Jairia Dela Cruz, 31 Oct 2018
The question of whether to exercise or not typically emerges in the setting of chronic pain, as patients fear that moving may contribute to exacerbate their condition. Yet, exercise does exert hypoalgesic effects on chronic pain conditions however variable these effects are, according to a senior physiotherapist who spoke at the Singapore Health & Biomedical Congress 2018.
01 Dec 2015
Adding tofacitinib to treatment strategy decreases cost and improves quality-adjusted life-years in patients with moderate to severe rheumatoid arthritis (RA), as observed in a Canadian cost-effectiveness analysis.
21 Oct 2018
Individuals with increased femoral neck body mineral density (BMD) are highly likely to develop subsequent radiographic osteoarthritis of the knee and hip but not of the hand, a study suggests.
Audrey Abella, 16 Oct 2018
Individuals with diabetes have a higher risk of osteoarthritis, rheumatoid arthritis (RA), and osteoporosis, according to a Danish study presented at EASD 2018.