Arthritis Research UK Centre for Epidemiology, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK.
Institute of Translational Medicine (Child Health), University of Liverpool, UK.
Rheumatology (Oxford). 2019 Jan 1;58(1):94-102. doi: 10.1093/rheumatology/key262.
To investigate real-world short-term outcomes among patients with systemic JIA starting tocilizumab or anakinra.
This analysis included all systemic JIA patients within the UK Biologics for Children with Rheumatic Diseases study starting tocilizumab or anakinra between 2010 and 2016. Disease activity was assessed at baseline and one year. At one year the following outcomes were assessed: minimal disease activity, clinically inactive disease, 90% ACR Paediatric response (ACRPedi90). Univariable logistic regression was used to identify baseline characteristics associated with these outcomes. Multiple imputation was used to account for missing data.
Seventy-six systemic JIA patients were included (54 tocilizumab; 22 anakinra). More patients starting anakinra as their first biologic compared with tocilizumab (86% vs 63%; P = 0.04), with shorter disease duration (1 vs 2 years; P = 0.003) and higher frequency of prior macrophage activation syndrome (37% vs 8%; P = 0.004). Overall, at one year, 42% achieved ACRPedi90, 51% minimal disease activity, and 39% clinically inactive disease, with similar responses seen between the two drugs. Response was not associated with baseline disease characteristics. Fifteen (20%) patients stopped biologic treatment by one year. Treatment survival was better with tocilizumab (89% at one year vs 59% anakinra; P = 0.002), with three stopping for anakinra injection-related problems.
In this real-world cohort of patients with systemic JIA receiving tocilizumab or anakinra, approximately half achieved a minimal disease state by one year. Treatment responses appeared similar between the two therapies albeit with better persistence observed with tocilizumab.
研究开始使用托珠单抗或阿那白滞素的全身型幼年特发性关节炎患者的真实世界短期结局。
本分析纳入了 2010 年至 2016 年期间在英国儿童风湿病生物制剂研究中开始使用托珠单抗或阿那白滞素的所有全身型幼年特发性关节炎患者。在基线和 1 年时评估疾病活动度。在 1 年时评估以下结局：疾病最小活动度、临床无疾病活动、90% ACR 患儿缓解（ACRPedi90）。采用单变量逻辑回归确定与这些结局相关的基线特征。采用多重插补法处理缺失数据。
共纳入 76 例全身型幼年特发性关节炎患者（54 例使用托珠单抗，22 例使用阿那白滞素）。起始使用阿那白滞素作为一线生物制剂的患者多于托珠单抗（86%比 63%；P=0.04），且疾病病程更短（1 年比 2 年；P=0.003），既往巨噬细胞活化综合征的发生率更高（37%比 8%；P=0.004）。总体而言，1 年后，42%的患者达到 ACRPedi90，51%的患者达到疾病最小活动度，39%的患者达到临床无疾病活动度，两种药物的疗效相似。疗效与基线疾病特征无关。15 例（20%）患者在 1 年内停止生物制剂治疗。托珠单抗的治疗存活率更好（1 年时为 89%，阿那白滞素为 59%；P=0.002），有 3 例因阿那白滞素注射相关问题而停药。
在本项接受托珠单抗或阿那白滞素治疗的全身型幼年特发性关节炎真实世界队列中，大约一半的患者在 1 年内达到疾病最小活动度。尽管托珠单抗的治疗持续时间更长，但两种治疗方法的疗效似乎相似。
