Yan Xin, Tang Wenjing, Zhang Zhiyong, Zhang Yu, Luo Chong, Tang Xuemei
Department of Rheumatology and Immunology, Children's Hospital of Chongqing Medical University, Chongqing, China.
Chongqing Key Laboratory of Child Infection and Immunity, Children's Hospital of Chongqing Medical University, Chongqing, China.
Front Pediatr. 2021 Nov 8;9:735846. doi: 10.3389/fped.2021.735846. eCollection 2021.
We performed a single-center retrospective study to determine the different efficacy of tocilizumab (TCZ) in the early and late stages and in three phenotypic subgroups (monocyclic, polycyclic, and persistent) of systemic juvenile idiopathic arthritis (sJIA). Clinical and serological parameters of 77 sJIA patients treated by TCZ were collected from November 1, 2013 to May 1, 2019. Patients were grouped based on the duration group A < 6 months ( = 41) and group B > 6 months ( = 36) and divided into three phenotypes: monocyclic ( = 12), polycyclic ( = 14), and persistent ( = 51) course. At baseline, group A had pronounced ESR, fever less active arthritis than group B ( < 0.05). After 12 weeks of therapy, TCZ alleviated fever, ESR, CRP, and systemic-onset juvenile arthritis disease activity score-27 (sJADAS27) in both group A and group B (>0.05), while the efficacy of TCZ in relieving active arthritis in group A was better than that in group B (<0.05). After 1 year of TCZ therapy, it showed that patients with monocyclic phenotype had the highest clinical response rate (91.7%, odds ratio = 0, 95% CI: 24-24, = 0.00), followed by the polycyclic (28.6%, odds ratio = 2.1, 95% CI: 10.5-18.8, = 0.00) and the persistent course (9.8%, odds ratio = 1.2, 95% CI: 9.5-13.8, = 0.00). TCZ can quickly relieve fever and inflammation, especially when patients have less active arthritis with shorter disease duration. The long-term efficacy of TCZ is related to the phenotypes, among which the monocyclic is the best, and the persistent is the worst.
我们进行了一项单中心回顾性研究，以确定托珠单抗（TCZ）在全身型幼年特发性关节炎（sJIA）的早期和晚期以及三种表型亚组（单循环、多循环和持续性）中的不同疗效。收集了2013年11月1日至2019年5月1日期间接受TCZ治疗的77例sJIA患者的临床和血清学参数。患者根据病程分组，A组<6个月（n = 41），B组>6个月（n = 36），并分为三种表型：单循环病程（n = 12）、多循环病程（n = 14）和持续性病程（n = 51）。在基线时，A组的血沉、发热情况及关节炎活动度均比B组明显更低（P<0.05）。治疗12周后，TCZ使A组和B组的发热、血沉、C反应蛋白及全身型幼年关节炎疾病活动评分-27（sJADAS27）均得到缓解（P>0.05），而TCZ缓解A组活动性关节炎的疗效优于B组（P<0.05）。TCZ治疗1年后，结果显示单循环表型患者的临床缓解率最高（91.7%，优势比 = 0，95%可信区间：24 - 24，P = 0.00），其次是多循环表型（28.6%，优势比 = 2.1，95%可信区间：10.5 - 18.8，P = 0.00）和持续性病程表型（9.8%，优势比 = 1.2，95%可信区间：9.5 - 13.8，P = 0.00）。TCZ能迅速缓解发热和炎症，尤其是当患者关节炎活动度较低且病程较短时。TCZ的长期疗效与表型有关，其中单循环表型最佳，持续性表型最差。
