Biologics Help Speed Remission in Systemic JIA

A new study shows that children newly diagnosed with systemic juvenile idiopathic arthritis whose first line of treatment is with a biologic drug, successfully emerged from treatment  without any systemic symptoms of JIA - and some of the children were deemed to be in clinical remission. The study, published in the Aug. 11 issue of the BMJ journal RMD Open, tracks the use of interleukin-1 (IL-1) or IL-6 inhibitors, also known as biologics, as a first-line therapeutic in 77 patients with systemic juvenile idiopathic arthritis (SJIA) between Jan. 1, 2005 and June 30, 2012. Researchers compared the outcomes of treatments with those two biologics against patients who were treated with tumor necrosis-alpha (TNF-α) blockers, which are generally prescribed first for SJIA.

What does this study add?

Introducing an IL-1 or an IL-6 inhibitor as a first biologic treatment dramatically increases the chances of SJIA patients to ever achieve CR, as compaired to TNF-alpha inhibitors, even if some patients may achieve CR on canakinumab or tocilizumab as second or third line biologic agents. How could this study impact clinical practice?In biologic-naive SJIA patients, any IL-1 or an IL-6 inhibitor may be recommended in a treatto-target approach aiming to achieve inactive disease within a few months; in non-biologic naive SJIA patients, canakinumab and tocilizumab seem the best options to try and obtain complete remission. Source:  RMD Open The marker for success was in having patients achieve inactive disease status, which is defined as being asymptomatic for six months or longer, or clinical remission, which is considered disease free for 12 months or more after treatment. The results were telling:  SJIA patients who started out on IL-1inhibitors achieved inactive disease at a higher rate as compared to patients who received TNF blockers as a first-line therapeutic. More than half of the patients (51.9% of the study population) with inactive disease achieved clinical remission at last follow-up (median 22 months). Patients in the study, almost equally boys and girls (median age 4 years old) had SJIA for approximately two years and virtually all had previously been on non-steroidal anti-inflammatory drugs (NSAIDs) and/or corticosteroids, with about a third on methotrexate (MTX) at baseline.

Among those achieving clinical remission, 27 did so after stopping steroids. Among the group, 51 children started on anakinra, 12 on the TNF-α blocker etanercept (Enbrel), 10 with another IL-1 drug canakinumab (Ilaris), 2 on the IL-6 inhibitor tocilizumab (Actemra), and one each on adalimumab (Humira), a TNF drug, and abatacept (Orencia), a fusion protein that targets CTLA-4. Investigators, led by Andreas Woener at the Hôpital Necker-Enfants Malades in Paris, report that 48% (n=37) of the children achieved and maintained inactive disease without switching to another biologic, but when the initial treatment didn’t work or the side effects became intolerable, the patients switched to another biologic. The switch to a second (n=34), third (n=18) or fourth (n=4) biologic led to an inactive disease status for an additional 13 patients who received either on canakinumab (n=6) or tocilizumab (n=7). Achieving inactive disease was more difficult after switching biologics, but no new safety concerns for any of the drugs emerged. Several biological agents have become available for the treatment of SJIA over the last decade, with the first available being etanercept, a tumour necrosis factor (TNF)-α receptor antagonist. By contrast, tumor necrosis-alpha (TNF-α) blockers are usually used as a first-line treatment for SJIA in combination with other therapies.

Disclosures:

This study was partially supported by a grant from Novartis SA, France.

References:

Woerner A, Uettwiller F, Melki I, et al. Biological treatment in systemic juvenile idiopathic arthritis: achievement of inactive disease or clinical remission on a first, second or third biological agent. RMD Open. Aug. 11, 2015. doi:10.1136/rmdopen-2014-000036.