Response to canakinumab sustained for up to 5 years in children with sJIA
medwireNews: Response to canakinumab therapy is sustained or even improved for up to 5 years in children with systemic juvenile idiopathic arthritis (sJIA), with no new safety signals, according to the results of a long-term extension study published in the Annals of the Rheumatic Diseases.
Among 177 individuals aged 2–19 years with sJIA and active systemic features and arthritis at baseline, 44.6% achieved a Juvenile Arthritis disease Activity Score (JADAS) indicating low disease activity (JADAS ≤3.8) or inactive disease (JADAS ≤1) in the first 6 months of canakinumab therapy, with this percentage increasing to 48.6% at 2 years and being maintained for up to 5 years.
And of 128 participants on glucocorticoids at the start of the study, 44% had discontinued this therapy by study end and 22% had tapered glucocorticoids to below 0.2 mg/kg per day. Glucocorticoid discontinuation occurred rapidly in some participants and over a longer period in others, suggesting “a continuous glucocorticoid tapering effect of canakinumab,” say Nicolino Ruperto (Istituto G Gaslini, Genova, Italy) and co-researchers.
The researchers also found that “[e]arly response seemed to be a predictive factor of long-term outcome enabling physicians to incorporate in their decision-making the time to response in the consideration of changing canakinumab to another treatment.”
A total of 96 (54.2%) individuals were defined as early responders (those who responded to canakinumab quickly and successfully tapered glucocorticoids), while 48 (27.1%) were late responders (who did not have an initial response to canakinumab or who were unable to taper glucocorticoids).
The late responders showed a median decrease in disease activity of 64.6% at 6 months (median decrease in JADAS of 24.9) and 93.5% (median decrease in JADAS of 31.8) after 2 years of canakinumab therapy. Despite these improvements, however, these participants continued to have high disease activity, with a JADAS of more than 10.5, and were more likely to discontinue treatment than early responders.
By comparison, early responders improved their JADAS by a median of 96.4% (median decrease in JADAS of 25.1) in the first 6 months after starting canakinumab, with the improvement maintained over at least 2 years, at a median of 99.2% (median decrease in JADAS of27.6).
Although this study was possibly limited by its low retention rate, with 58% of individuals discontinuing canakinumab over the 5 years, the researchers note that this would “typically [be] expected in a study with such long follow-up.”
They conclude: “Further ongoing studies of canakinumab in other sJIA cohorts should address any limitations of the current study.”
By Catherine Booth
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