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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
4 days ago

Dr Michael Lim, a senior consultant at the Paediatric Pulmonary and Sleep Division, National University Hospital, Singapore, speaks to Roshini Claire Anthony on the rare disease that is cystic fibrosis.

2 days ago
Susceptibility‐guided therapy is as effective as empiric modified bismuth quadruple therapy for the first-line treatment of Helicobacter pylori infection, with both yielding excellent eradication rates, as shown in a recent trial.
4 days ago
It appears that long-term consumption of fish and omega-3 fatty acid does not influence the risk of incident hypertension in middle-aged and older men, suggests a US study.
2 days ago
The risk factors and outcomes associated with an increased risk of permanent pacing include atrial fibrillation (AF) ablation, multivalve surgery and New York Heart Association (NYHA) functional class III/IV, a recent study has found.