Тоцилизумаб в лечении детей с системным вариантом ювенильного артрита: анализ факторов, влияющих на эффективность терапии в долгосрочном периоде

Abstract

The introduction of tocilizumab — a drug that blocks interleukin 6 — into the practice of pediatric rheumatologists is an important achievement in the treatment of systemic juvenile arthritis (SJA). Objective : Our aim was to identify factors associated with the level of treatment response and safety of tocilizumab in the treatment of children with SJA. Methods: We examined children with SJA (n =49) who received tocilizumab from November 2009 to June 2014. The therapy efficiency was evaluated according to the ACR pedi criteria. Results: The initial positive response to the tocilizumab therapy was found in 100% of patients. At the end of the five-year monitoring period, 38 patients were still treated with tocilizumab with the response of more than 50% according to the pediatric criteria of the American College of Rheumatology. Steady improvement reduced the dose of corticosteroids in all patients. The dose of corticoids was cancelled in 11% of patients and non-steroidal anti-inflammatory drugs were cancelled in 14% of patients. At the end of the study, 10 patients had an inactive disease status. The lower response to the treatment was recorded at the onset of the disease in children at the age of 3 and below and in patients with longer duration of disease due to the violation of the tocilizumab administration and dosing terms and late correction of the concomitant therapy. There were no differences in response to the therapy depending on the previous use of genetically engineered biological agents. The most common adverse effects were neutropenia and infections. The reasons for the withdrawal of tocilizumab were serious adverse responses (n =6) and termination of the therapy in regional centers at the place of residence for organizational reasons (n=5). Conclusion: If there are unfavorable prognosis factors (onset at the age of 3, formation of early polyarthritis, and polyserositis), tocilizumab should be appointed at earlier dates. Violation of the terms for the drug administration and late correction of the concomitant therapy reduce the efficiency of the drug.