Monday, 18 Jun 2018

You are here

IL-6 Inhibition Most Effective in Polycyclic Systemic JIA

The German Autoinflammatory Disease (AID) registry has studied the effects of the IL-6 inhibitor tocilizumab (TCZ) in systemic juvenile idiopathic arthritis (sJIA) patients and shown a clinical response rate of 35% during the first 12 weeks, and inactive disease and/or remission (with medication) in 75% at 12 months.

Tocilizumab is one of but a few biologics approved for use in sJIA.  While there appears to be a major role for proinflammatory cytokines, like interleukin-6 (IL-6), it is often unclear what the best first therapy should be in this complex autoinflammatory disorder.

The Germain AID registry was established in 2009 (https://aid-register.de). They performed a retrospective review of their TCZ experience from 13 centers.

Of th 200 sJIA patients in the registry, 46 (age 1–18 years) received therapy with TCZ and nearly half have received long term TCZ treatment (median 23 months).

While there are no standardized validated primary endpoint outcomes for sJIA (Still's disease), these investigators defined clinical response as no clinical manifestation, no increased inflammation parameters) within the first 12 weeks of treatment. They used the Wallace criteria for responses at 12 months and designated patients as having active disease (AD), inactive disease (ID) and clinical remission on medication (CRM). Inactive disease (ID) required no active arthritis, no fever, no exanthema, no serositis, no splenomegaly, no lymphadenopathy, no active uveitis, normal ESR and CRP, no disease activity in physician’s report. CRM was defined as ID for at least 6 months. 

The week 12 response rate was calculated to be 35%.  DMARDs were used in 72% of patients before TCZ therapy.

At 12 months 39.1% achieved an inactive disease and CRM was seen in 30.4% according to the Wallace criteria. Overall a favourable outcome under TCZ treatment was reported for 32/46 (69.6%) of the patients in the registry. 

The clinical course clearly influenced response rates. The highest clinical response rate (81%) was seen with the polycyclic  course, followed by a 59% response with a monocyclic course and the worst outcome for patients with a polyarticular course (29%).

Adverse events were seen in 24% and severe adverse events in 4%.

 

Disclosures: 
The author has received compensation as an advisor or consultant on this subject

Add new comment

More Like This

High Biologic Blood Levels Increases the Risk of Infections in RA

A big concern of most is the risk of infection with use of tumour necrosis factor inhibitor (TNFi) and biologic drugs.  While studied in both trials and in post-marketing studies, it is unknown if infection risk is dose-dependent.

In abstract OP0229 UK researchers have shown high biologic blood levels are associates with an increased risk of total infections in RA, but not serious infetions.

Biosimilar Data at #EULAR2018

Biosimilars are here, and more are being registered all the time, so I was really interested in the biosimilar data at the meeting.

Abbvie Highlights Upadacitinib Trials at EULAR18

Abbvie press releases feature the results from 3 new trials to be presented during the Annual European Congress of Rheumatology (EULAR 2018) in Amsterdam from three Phase 3 trials evaluating upadacitinib, an investigational, once-daily oral JAK1-selective inhibitor, in adult patients with moderate to severe rheumatoid arthritis.

Vedolizumab Implicated in Exacerbations of SpA in IBD Patients

Beloved by gastroenterologist for treatment of inflammatory bowel disease (IBD), α4β7 integrin receptor vedolizumab (VDZ) has probably caught attention of many rheumatologist since the time it entered the market; largely for what it won't do for inflammatory arthritis.

JAK Inhibition in Autoinflammatory Syndromes Interferonopathies

While many autoinflammatory syndromes are driven and managed with select inhibition of IL-1, IL-18 or IL-6, a subset are driven by type I interferon and are referred to as interferonopathies. These monogenic IFN–mediated disorders present in infancy with fevers, systemic inflammation, an IFN response gene signature, inflammatory organ damage, and high mortality.