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15-10-2018 | Rheumatology | News | Article

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

medwireNews is an independent medical news service provided by Springer Healthcare. © 2018 Springer Healthcare part of the Springer Nature group

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