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Effect of tocilizumab on growth impairment in systemic juvenile idiopathic arthritis with long-term corticosteroid
Takako Miyamae1, Susumu Yokoya, Hisashi Yamanaka
1Department of Pediatrics, Yokohama City University , Yokohama , Japan.
Insights
Tocilizumab (TCZ) treatment in children with systemic juvenile idiopathic arthritis (sJIA) showed improved height velocity, especially when corticosteroid use was reduced. This indicates potential for catch-up growth in sJIA patients during TCZ therapy.
Area of Science:
- Pediatric Rheumatology
- Immunology
- Endocrinology
Background:
- Systemic juvenile idiopathic arthritis (sJIA) is a chronic inflammatory condition in children.
- Tocilizumab (TCZ), an anti-IL-6 receptor monoclonal antibody, is used to treat sJIA.
- Growth impairment is a concern in children with sJIA.
Purpose of the Study:
- To analyze the growth of children with sJIA during treatment with TCZ.
- To evaluate factors influencing growth, including disease duration and corticosteroid use.
Main Methods:
- Forty-five sJIA patients were enrolled, with analysis of height standard deviation score (HTSDS) and height velocity standard deviation score (HVSDS).
- Correlation between growth changes (∆SDS) and factors like age, disease duration, and corticosteroid exposure was assessed.
- Yearly height velocity was compared before and after TCZ treatment.
Main Results:
- 84% of patients achieved clinical response by week 144.
- Baseline HTSDS was negatively correlated with disease duration.
- Significant improvement in HVSDS was observed after TCZ initiation, particularly with reduced corticosteroid use.
Conclusions:
- Growth impairment in sJIA is linked to longer disease duration.
- TCZ treatment facilitates catch-up growth, especially in patients with reduced corticosteroid requirements.
Background:
The safety and efficacy of tocilizumab (TCZ), an anti-IL-6 receptor monoclonal antibody, have been reported in the treatment of children with systemic juvenile idiopathic arthritis (sJIA).
Objectives:
Growth of children during the TCZ study was analyzed.
Methods:
Forty-five sJIA patients (8.1 ± 4.2 years) were enrolled. Mean standard deviation score (SDS) for height (HTSDS), height velocity (HVSDS) and changes in SDS from baseline (∆SDS) were determined. Correlation between ∆SDS and several factors such as age, disease duration and corticosteroid exposure were evaluated. Yearly height velocity was analyzed for 28 patients for whom we had data for 1 year prior to TCZ administration and who had received TCZ for more than 1 year.
Results:
Of the 45 patients, 38 (84%) obtained a clinical response at week 144. The mean baseline HTSDS was - 2.7 ± 2.0 and inversely correlated with disease duration. Significant improvement was seen in change in HVSDS from 1 year prior to 1 year after baseline (- 6.0 ± 4.0 to - 2.5 ± 3.9, p = 0.0064). Reduction in corticosteroid exposure was significantly associated with improvement in HVSDS (p = 0.0027).
Conclusions:
Growth impairment evidenced by HTSDS was more prominent in patients with longer standing disease. Catch-up growth was observed in patients who required less or no corticosteroid during TCZ treatment.
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