Yasuoka Ryuhei, Iwata Naomi, Abe Naoki, Kohagura Toaki, Nakaseko Haruna, Shimizu Masaki, Kawabe Shinji
a Department of Infection and Immunology , Aichi Children's Health and Medical Center , Aichi , Japan.
b Department of Pediatrics, School of Medicine, Institute of Medical, Pharmaceutical and Health Sciences , Kanazawa University , Kanazawa , Japan.
Mod Rheumatol. 2019 Mar;29(2):324-327. doi: 10.1080/14397595.2018.1457490. Epub 2018 Apr 16.
The objective of this study is to identify risk factors for hypersensitivity reaction (HSR) to tocilizumab (TCZ) in systemic juvenile idiopathic arthritis (sJIA).
Clinical records of 40 patients with sJIA administered TCZ at one center were retrospectively reviewed. Patients were divided into HSR or non-HSR groups depending on the presence of HSR between the first and third TCZ administrations; clinical and laboratory assessments, including serum cytokine profile, were compared.
Five patients displayed HSR following the third TCZ administration. They were significantly younger, shorter, and lighter, with a higher peak body temperature than non-HSR patients following the third administration. Their serum C-reactive protein (CRP) level was undetectable following the first administration but detectable by the third administration. Before the third administration, the white blood cell counts and serum levels of CRP and sTNFRII were significantly higher in the HSR group than in the non-HSR group. The serum levels of interleukin-18 and -6 before the third TCZ administration were higher and lower than those before the first administration in the HSR and non-HSR groups, respectively.
Patients with sJIA having a younger age, shorter stature, and lighter weight and those showing increased disease activity in the early period of TCZ administration may be at higher risk of TCZ-induced HSR.
本研究旨在确定全身型幼年特发性关节炎（sJIA）患者对托珠单抗（TCZ）发生超敏反应（HSR）的危险因素。
回顾性分析在一个中心接受TCZ治疗的40例sJIA患者的临床记录。根据首次和第三次TCZ给药之间是否发生HSR，将患者分为HSR组或非HSR组；比较临床和实验室评估结果，包括血清细胞因子谱。
5例患者在第三次TCZ给药后出现HSR。与第三次给药后的非HSR患者相比，他们年龄更小、身高更矮、体重更轻，体温峰值更高。首次给药后其血清C反应蛋白（CRP）水平不可测，但第三次给药时可测。第三次给药前，HSR组的白细胞计数、CRP和sTNFRII血清水平显著高于非HSR组。在HSR组和非HSR组中，第三次TCZ给药前白细胞介素-18和-6的血清水平分别高于和低于首次给药前。
年龄较小、身材较矮、体重较轻且在TCZ给药早期疾病活动增加的sJIA患者，发生TCZ诱导的HSR的风险可能更高。
