Article

Juvenile Idiopathic Arthritis Drug Shows Promise

Author(s):

Patients with severe refractory juvenile idiopathic arthritis-associated uveitis may achieve complete remission with tocilizumab.

Most patients with severe refractory juvenile idiopathic arthritis-associated uveitis may get complete remission after six months of treatment with tocilizumab (Actemra/Roche), a research team in Spain reported.

To determine the effectiveness of the drug in treating uveitis associated with juvenile idiopathic arthritis (JIA), the team did a multicenter study of patients whose JIA-associated uveitis was refractory to conventional immunosuppressants and anti-tumor necrosis factor-α (TNF-α) agents. The team was led by Vanesa Calvo-Rio, MD, PhD, and Montserrat Santos-Gomez, MD, both of the University of Cantabiria, Santander, Spain.

The study population used included 21 women and 4 men; its mean age was 19 years. They had previously received corticosteroids, conventional immunosuppressants, and a median of two biologic agents, most frequently adalimumab (Humira/Abbvie) (in 24). Other biologics used included etanercept (Enbrel/Amgen), infliximab (Remicade/Janssen), abatacept (Orencia/Bristol Myers-Squibb), rituximab (Rituxan/Roche), anakinra (Kineret/Sobi, and golimumab (Simponi/Janssen).

In the patients treated with tocilizuman, best-corrected visual acuity increased 13% and central macular thickness decreased 35%. Improvement in vision persisted after one year, and complete remission occurred in 76% of patients.

In 22 of the 47 affected eyes, uveitis was bilateral. Nine patients also had cystic macular edema. Eyes showed wide range of ocular sequelae of JIA-associated uveitis, including band keratopathy (12), cataract (13), glaucoma (7), and synechiae (10). Maculopathy (9) and amblyopia (5) were also reported.

In most cases, 8 mg/kg of Actemra were given intravenously every 4 weeks. After Actemra therapy, all ocular parameters rapidly improved. After six months of Actemra, best-corrected visual acuity increased from 0.56 to 0.64 (P < 0.01). In addition, central macular thickness measurements by optical coherence tomography (OCT) showed that edema decreased from approximately 400 μm to 260 μm (P = 0.012). Also, nearly 80% of patients showed an improvement in the number of anterior chamber cells after 6 months of therapy, and nearly 90% showed such an improvement at 1 year.

Improvement in vision was found to have persisted after a median of 1 year of follow-up. Complete remission of uveitis occurred in 19 of 25 patients, or 76%. Moreover, patients were able to achieve a substantial reduction in prednisone dose.

Reported adverse effects include severe autoimmune thrombocytopenia, bullous impetigo, and viral conjunctivitis. Pneumonia, then autoimmune anemia and thrombocytopenia, were also reported.

As a result of the study findings, the team concluded, “Tocilizumab appears to be a useful therapy in severe refractory JIA-associated uveitis.”

Newsletter

Stay informed on drug updates, treatment guidelines, and pharmacy practice trends—subscribe to Pharmacy Times for weekly clinical insights.

Related Videos
Tired scared retiree man holding chest with anginal symptoms, pallor and diaphoresis at home. Suffering male with cardiac origin pain, prexcordial pressure, arrhythmia risk, urgent medical attention - Image credit: DimaBerlin | stock.adobe.com
5 experts in this video
Image credit: Sebastian Kaulitzki | stock.adobe.com
1 expert is featured in this series.
Magnified bone marrow biopsy showing plasma cells with irregular nuclei and multiple myeloma tumor cells infiltrating normal hematopoietic tissue
Health and nutrition: the role of glp-1 in diabetes management with apple and syringe - Image credit: Thanayut | stock.adobe.com