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6 days ago
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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
6 days ago
Older women with longer endogenous oestrogen exposure and hormone therapy use are at much higher odds of having favourable cognitive status in late life, a recent study suggests.
4 days ago
In patients with atrial fibrillation (AF) and stable coronary artery disease (CAD), rivaroxaban monotherapy is noninferior to combination treatment with an antiplatelet therapy in terms of cutting the risk of cardiovascular events and mortality, according to data from the AFIRE trial.
Elvira Manzano, 5 days ago
Supplementation with omega-3 fatty acids or vitamin D3 for up to 5 years has no effect on kidney function in adults with type 2 diabetes (T2D), the VITAL-DKD* ancillary study has shown.
Jairia Dela Cruz, 2 days ago
Many patients with nonvalvular atrial fibrillation (NVAF) in Thailand use anticoagulants, but the uptake of nonvitamin-K oral anticoagulants remains suboptimal despite showing an upward trend, according to data from the COOL-AF registry presented at the European Society of Cardioloy (ESC) Asia Congress 2019 with APSC and AFC.