Efficacy and safety of tocilizumab in patients with polyarticular-course juvenile idiopathic arthritis: results from a phase 3, randomised, double-blind withdrawal trial. Academic Article uri icon

Overview

abstract

  • OBJECTIVE: To evaluate the interleukin-6 receptor inhibitor tocilizumab for the treatment of patients with polyarticular-course juvenile idiopathic arthritis (pcJIA). METHODS: This three-part, randomised, placebo-controlled, double-blind withdrawal study (NCT00988221) included patients who had active pcJIA for ≥6 months and inadequate responses to methotrexate. During part 1, patients received open-label tocilizumab every 4 weeks (8 or 10 mg/kg for body weight (BW) <30 kg; 8 mg/kg for BW ≥30 kg). At week 16, patients with ≥JIA-American College of Rheumatology (ACR) 30 improvement entered the 24-week, double-blind part 2 after randomisation 1:1 to placebo or tocilizumab (stratified by methotrexate and steroid background therapy) for evaluation of the primary end point: JIA flare, compared with week 16. Patients flaring or completing part 2 received open-label tocilizumab. RESULTS: In part 1, 188 patients received tocilizumab (<30 kg: 10 mg/kg (n=35) or 8 mg/kg (n=34); ≥30 kg: n=119). In part 2, 163 patients received tocilizumab (n=82) or placebo (n=81). JIA flare occurred in 48.1% of patients on placebo versus 25.6% continuing tocilizumab (difference in means adjusted for stratification: -0.21; 95% CI -0.35 to -0.08; p=0.0024). At the end of part 2, 64.6% and 45.1% of patients receiving tocilizumab had JIA-ACR70 and JIA-ACR90 responses, respectively. Rates/100 patient-years (PY) of adverse events (AEs) and serious AEs (SAEs) were 480 and 12.5, respectively; infections were the most common SAE (4.9/100 PY). CONCLUSIONS: Tocilizumab treatment results in significant improvement, maintained over time, of pcJIA signs and symptoms and has a safety profile consistent with that for adults with rheumatoid arthritis. TRIAL REGISTRATION NUMBER: NCT00988221.

authors

  • Onel, Karen
  • Brunner, Hermine I
  • Ruperto, Nicolino
  • Zuber, Zbigniew
  • Keane, Caroline
  • Harari, Olivier
  • Kenwright, Andrew
  • Lu, Peng
  • Cuttica, Ruben
  • Keltsev, Vladimir
  • Xavier, Ricardo M
  • Calvo, Inmaculada
  • Nikishina, Irina
  • Rubio-Pérez, Nadina
  • Alexeeva, Ekaterina
  • Chasnyk, Vyacheslav
  • Horneff, Gerd
  • Opoka-Winiarska, Violetta
  • Quartier, Pierre
  • Silva, Clovis A
  • Silverman, Earl
  • Spindler, Alberto
  • Baildam, Eileen
  • Gámir, M Luz
  • Martin, Alan
  • Rietschel, Christoph
  • Siri, Daniel
  • Smolewska, Elzbieta
  • Lovell, Daniel
  • Martini, Alberto
  • De Benedetti, Fabrizio

publication date

  • May 16, 2014

Research

keywords

  • Antibodies, Monoclonal, Humanized
  • Antirheumatic Agents
  • Arthritis, Juvenile
  • Maintenance Chemotherapy
  • Receptors, Interleukin-6

Identity

PubMed Central ID

  • PMC4431348

Scopus Document Identifier

  • 84932604292

Digital Object Identifier (DOI)

  • 10.1136/annrheumdis-2014-205351

PubMed ID

  • 24834925

Additional Document Info

volume

  • 74

issue

  • 6