Biologic Treatment in Systemic Juvenile Idiopathic Arthritis: Single Center Experience

Buthaina Al adba¹, Rayfel Schneider² and Earl Silverman³, ¹paediatric rheumatology, sickkids hospital, Toronto, ON, Canada, ²Rheumatology, The Hospital for Sick Children, Toronto, ON, Canada, ³Division of Rheumatology, Hosp for Sick Children, Toronto, ON, Canada

Meeting: 2014 ACR/ARHP Annual Meeting

Keywords: biologic drugs and pediatric rheumatology, Systemic JIA

Session Information

Title: Pediatric Rheumatology - Clinical and Therapeutic Aspects: Systemic Juvenile Idiopathic Arthritis, Spondyloarthropathy and Miscellaneous Pediatric Rheumatic Diseases

Session Type: Abstract Submissions (ACR)

Background/Purpose:

The prevalence of juvenile idiopathic arthritis (JIA) is approximately 3.3/1000 children and 10- 15% have the systemic form (SJIA). Biologics, specifically anti-IL -1 and anti-IL-6 agents have been introduced to decrease the need for corticosteroids and therefore ameliorate the associated morbidity including growth failure, cataracts, fractures and body image problems

Methods:

Study design:

Retrospective chart review of 306 patients diagnosed with SJIA at Hospital of sick children from January 1980 to December 2012. Exclusion criteria: Diagnosis not confirmed, <1 year follow-up, <1 visit per year and unable to obtain complete medical record.

Data analysis:

1) Number of patients treated with biologics.

2) Response of: i) Systemic features (fever or rash) and ii) Arthritis. 

3) Definition of response for systemic features i) Complete response: no symptoms off steroids. ii) Partial response: no symptoms but on steroids.

4) Definition of response for arthritis: i) Complete response: no active arthritis ii) Partial response: >50% improvement in active joint count.

Results:

The cohort consisted of 306 SJIA patients which 58 of them (18%) have received biologic. 28/58 (48%) Since 2009. The main biologic used are anti-IL-1 , anti-IL-6 and anti TNF. 41/58 needs one biologic, 10/58 two biologic and 7/58 three or more. Some patients used same biologic more than once. Anti IL-1 was used 47 times in the 58 patients (81%), anti IL-6 used 14 times (24%) and anti TNF used 38 times (65%). The complete response of systemic features was about 70% in both anti IL-1 and anti IL-6 group, however it was 20% in anti TNF group. The complete response of arthritis was 64%, 48% and 31% in anti IL-6, anti IL-1 and anti TNF respectively.

SUMMARY: 1) 58/306 received biologic during the study- 28/58 (48%) since 2009. 2)The main biologics used were: anti-IL-1, anti-IL-6 and anti-TNF agents.3) A complete response of systemic features was found in about 70% for both anti-IL-1 and anti- IL-6 groups but only 20% in the anti-TNF group. 4)A complete response of arthritis was seen in 64%, 48% and 31% in the anti-IL-6, anti-IL-1 and anti-TNF groups respectively

Conclusion

1) Since 2009 there was a significant increase in the use of biologic therapies in SJIA.  2) Systemic features responded well to anti- IL-1 and anti- IL-6 but not anti-TNF treatment.3) Arthritis improved by >66% with anti-IL-1 and anti-IL-6 in all patients but not with anti-TNF treatment.4) Further studies with large number of patients are needed to evaluate anti-IL-1 and anti-IL-6. 5) With anti-IL-1 and anti-IL-6 agents, a substantial proportion of patients were able to discontinue steroid.

Disclosure:

B. Al adba,
None;

R. Schneider,
None;

E. Silverman,
None.

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