Tocilizumab may delay joint damage in JIA
medwireNews: The majority of patients with systemic juvenile idiopathic arthritis (sJIA) or polyarticular-course juvenile idiopathic arthritis (pcJIA) do not develop radiographic joint progression during the first 2 years of tocilizumab treatment, research shows.
Using standard radiographs of both wrists and hands in the posteroanterior view, collected during the TENDER and CHERISH randomized controlled trials, Angelo Ravelli (Università degli Studi di Genova, Genoa, Italy) and co-authors found that “[t]here was little change in radiographic scores of structural joint damage” over this period.
At baseline, the median adapted Sharp–van der Heijde (aSH) score among 47 of the 112 TENDER participants with sJIA was 24.6 points while the median Poznanski score, available for 33 participants, was −2.38 points.
At 1 year, there was no change from baseline in the median aSH score and a significant 0.29-point increase in Poznanski score; at 2 years, the aSH had increased by a nonsignificant 0.5 points from baseline, while the Poznanski score was a nonsignificant 0.16 points higher versus baseline.
Defining radiographic progression using the smallest detectable difference (SDD) of 23.6 points and 0.58 points for the aSH and Poznanski scores, respectively, the researchers calculated that, at 1 year, progression rates among the sJIA patients were 0.0% and 9.4%, respectively.
At 2 years, the radiographic progression rates according to aSH and Poznanski scores had increased to a respective 5.4% and 11.5%.
For the CHERISH participants with pcJIA, the median baseline aSH score was 8.0 points (n=45 of 188) and the median Poznanski score was –1.45 points (n=35 of 188) .
After 1 year of tocilizumab treatment, the median aSH and Poznanski scores had increased by a nonsignificant 0.5 points and 0.26 points, respectively. At 2 years, the aSH score had fallen by a nonsignificant 1.0 points versus baseline, while the Poznanski score had increased by a significant 0.55 points.
The rates of aSH- and Poznanski-defined radiographic progression, based on SDDs of 9.76 and −0.88 points, respectively, were 12.5% and 6.5% at 1 year, and 2.9% and 4.0% at 2 years.
Ravelli and co-authors conclude in Arthritis Research & Therapy that, taken together, their findings “indicate that tocilizumab is potentially capable of halting the progression of radiographic joint damage in children with JIA.”
However, they add that “because the natural course of arthritis in children is heterogeneous and a control group not exposed to tocilizumab was not available, we cannot draw definitive conclusions regarding the ability of tocilizumab to halt or diminish radiographic progression in JIA, and our findings should be confirmed in future studies.”
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