A small study from The Netherlands has renewed hope that IL-1 receptor antagonists might be helpful for patients with systemic juvenile idiopathic arthritis (JIA).
Anakinra (brand name Kineret), a biologic that blocks IL-1 activity, has been trialed in JIA patients since 2011.
But in the first trials only 30% of patients had completely inactivated disease after one year and the therapy usually had to be combined with glucocorticoid steroids and other DMARDs.
Now, researchers from The Netherlands have trialed anakinra in JIA patients using a slightly different strategy.
They gave the drug to 42 patients who had only just been diagnosed with JIA.
The IL-1 pathway activation is most prominent in the early phase of the disease, so this presents a “window of opportunity” for IL-1 receptor antagonists, the researchers said.
The results were striking, with 96% of JIA patients taking anakinra having inactive disease after five years of follow up. (Around three-quarters of patients taking anakinra had inactive disease without medication at five years.)
This study was not randomised and had a small cohort, so it was impossible to tell if the relationship was causal.
However, around half of JIA patients usually have persistent active disease for years, so it’s possible that Anakinra was having an effect in this study.
The single-centre Dutch prospective study, recently published in Arthritis and Rheumatology, found that anakinra monotherapy was highly effective within the first month of treatment for patients with systemic JIA.
After only one month of therapy, 55% of patient had completely inactive disease.
One year into the study, 76% of patients had inactive disease, and 52% had inactive disease while not receiving medication.
The participants had a mean age of seven years and presented with a new diagnosis of systemic JIA. This included 12 patients who had arthralgia but no arthritis at disease onset.
“The use of a biologic agent as first-line therapy is a paradigm shift compared to conventional step- up regimens used in systemic JIA,” the study authors said.
Systemic JIA differs from other forms of JIA and is often characterised by skin rashes, swelling of the liver and spleen, daily spiking fevers and an elevated erythrocyte sedimentation rate (ESR).
DMARDs, which are used to treat other forms of JIA have historically not provided relief for patients with systemic JIA, the study authors said.
Previous studiesfound long-term steroids which have been used to treat systemic JIA can lead to multiple adverse side-effects in children including obesity and stunted growth.
Arthritis & Rheumatology 2019, 8 March