Anakinra may curb Still's disease and juvenile arthritis

March 27, 2008

Ann Rheum Dis 2008;67:302-308.

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Reuters Health - Mar. 26, 2008

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NEW YORK (Reuters Health) - Patients with systemic-onset juvenile idiopathic

arthritis (JIA) or adult-onset Still's disease who are resistant to

conventional treatment, may benefit from therapy with the interleukin-1

(IL-1) receptor antagonist anakinra, French researchers report in the March

issue of the ls of the Rheumatic Diseases.

Dr. Pierre Quartier told Reuters Health that " anti-IL-1 treatment is worth

considering as a first line anti-cytokine treatment ... in patients with an

active, corticosteroid-dependent disease. Controlled trials are needed,

however, both to assess efficacy and safety. We need to better understand

why some patients are good responders and others not. "

Dr. Quartier of Hopital Necker-Enfants Malades, Paris and colleagues studied

20 patients (mean age, 12.4 years) who had had JIA for a mean of 7.0 years

and 15 (mean age, 38.1 years) who had had Still's disease for a mean of 7.8

years.

Children were treated with 1-2 mg/kg/day of anakinra and adults were given

100 mg/day.

The investigators note that although most Still's patients responded, less

than half of the JIA patients achieved a marked and sustained improvement.

Specifically, five of the patients with JIA (25%) had a 50% improvement by

ACR criteria at 6 months. Steroid use was reduced by 15% to 78% from

baseline in 10 of the JIA patients.

However, 11 (73%) of the Still's disease patients had " a prompt and dramatic

improvement in all disease markers. " At a mean follow-up of 17.5 months, two

of these patients had stopped corticosteroids and eight had reduced steroid

use by as much as 95%.

The team concludes that one issue to be addressed " is whether the anakinra

dose or the number of injections per day should have been increased in

patients that did not respond. " Little is known, they add, " about the

pharmacokinetics of anakinra in children. "

The author of an accompanying editorial, Dr. Woo of University

College, London, told Reuters Health that " this study confirms that blocking

the action of IL-1 works well in only a proportion of systemic-onset JIA

patients, and the available evidence suggests there are different disease

mechanisms that produce the clinical picture of systemic-onset JIA. "

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