Biological treatment in systemic juvenile idiopathic arthritis: achievement of inactive disease or clinical remission on a first, second or third biological agent

Abstract

ObjectivesTo analyse the effect of biological agents (BAs) in terms of achieving inactive disease (ID) or clinical remission (CR) in patients with systemic juvenile idiopathic arthritis (SJIA), to describe effects of switching or discontinuing a BA and to assess the proportion of patients able to maintain ID or CR off steroids and after withdrawing BA therapy.MethodsRetrospective study in a French paediatric rheumatology reference centre using the CEMARA (CEntre des MAladies RAres) register.ResultsSeventy-seven patients were included with a cumulative follow-up of 245.5 patient-years (median 1.1, range 0.5–8.0). On a first BA, ID was achieved in 37 patients, including 1 patient out of 12 patients on etanercept, 26 patients out of 51 on anakinra and 7 out of 10 on canakinumab. One patient on abatacept and two patients on tocilizumab also achieved ID. Switching of BA was common. The switch to a second (n=34), third (n=18) or fourth (n=4) BA resulted in ID in a further 13 patients, either on canakinumab (n=6) or tocilizumab (n=7). At last follow-up, 40 patients were in CR (27 patients off steroids, 5 patients having never received steroid treatment), either on (n=29) or off (n=11) BA.ConclusionsIn this series of patients with SJIA, interleukin-1 inhibitors were associated with a higher proportion of ID than tumour necrosis factor inhibitors when used as first BA. Switching allowed some patients to achieve ID when treated with canakinumab or tocilizumab. CR was eventually achieved in more than half of the patients.

Cytokine Biomarkers of Disease Activity and Therapeutic Response after Initiating Methotrexate Therapy in Patients with Juvenile Idiopathic Arthritis

“…The failure to observe this relationship with IL‐1α, IL‐1β, and IL‐1Ra levels suggests a less prominent role of these cytokines in this patient population. This finding is in line with the established efficacy of anti–TNF‐α and anti–IL‐6 therapies in patients with JIA, with anti–IL‐1 and anti–IL‐6 therapies primarily targeting the systemic form of JIA, which was inadequately represented in our study.…”

Discontinuation of Canakinumab following Clinical Disease Remission Is Feasible in Patients with Systemic Juvenile Idiopathic Arthritis

“…In general, biologic-naive patients demonstrate a swift and sustained response to IL-1 blockade 5 . Moreover, while multiple studies have shown clinical benefit of IL-1-targeted drugs such as recombinant IL-1Ra, not all patients responded equally well 6,7 ; nonetheless in our study 3/12 patients who did not respond to IL-Ra responded to canakinumab. Moreover, the protocols in the aforementioned trials did not include a plan for tapering or stopping the drug once remission had been achieved 8 .…”

Frequency of biologic switching and the outcomes of switching in children and young people with juvenile idiopathic arthritis: a national cohort study

“…The proportion of patients switching to a second biologic in our study was similar to that of a Dutch registry (26%), 7 but the proportion of patients with systemic juvenile idiopathic arthritis who started a second biologic was lower than that in a French retrospective study (44%). 19 The majority of patients recruited in the previous Dutch and French cohort studies started §For ACR Pedi 90 and minimal disease activity outcomes, patients who stopped biologic therapy before the 6-month outcome measurements were completed were classified as non-responders and those who stopped because they had achieved remission were classified as responders. treatment with their first biologic before 2010 and therefore might not be representative of current biologic prescribing patterns.…”