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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
05 Nov 2019
Low total cholesterol levels appear to carry increased major adverse cardiovascular events (MACE) hazard in older men without ischaemic heart disease (IHD) and not receiving statin therapy but not to those on statins, according to data from the CHAMP (Concord Health and Ageing in Men Project) cohort.
2 days ago
Better sleep appears to weaken pain and fatigue in older, community-dwelling adults with hip or knee osteoarthritis (OA), reports a recent study.
6 days ago
Maribavir 400 mg twice daily appears to have comparable efficacy to valganciclovir at clearing cytomegalovirus viraemia in transplant recipients, a study has found.
5 days ago
Individuals with and without gout appear to have a similar risk of developing colorectal cancer, suggesting that gout does not contribute to a risk increase, a study has found.