Dr. Prince has received consulting fees from Bristol-Myers Squibb (less than $10,000) and honoraria from Abbott, Bristol-Myers Squibb, Novartis Pharma, Teva Pharma, and Wyeth (less than $10,000 each).
Anakinra as first-line disease-modifying therapy in systemic juvenile idiopathic arthritis: Report of forty-six patients from an international multicenter series
Article first published online: 28 JAN 2011
Copyright © 2011 by the American College of Rheumatology
Arthritis & Rheumatism
Volume 63, Issue 2, pages 545–555, February 2011
How to Cite
Nigrovic, P. A., Mannion, M., Prince, F. H. M., Zeft, A., Rabinovich, C. E., van Rossum, M. A. J., Cortis, E., Pardeo, M., Miettunen, P. M., Janow, G., Birmingham, J., Eggebeen, A., Janssen, E., Shulman, A. I., Son, M. B., Hong, S., Jones, K., Ilowite, N. T., Cron, R. Q. and Higgins, G. C. (2011), Anakinra as first-line disease-modifying therapy in systemic juvenile idiopathic arthritis: Report of forty-six patients from an international multicenter series. Arthritis & Rheumatism, 63: 545–555. doi: 10.1002/art.30128
- Issue published online: 28 JAN 2011
- Article first published online: 28 JAN 2011
- Accepted manuscript online: 4 NOV 2010 01:00PM EST
- Manuscript Accepted: 26 OCT 2010
- Manuscript Received: 28 JUN 2010
- Samara Jan Turkel Center for Pediatric Autoimmune Disease
- Cogan Family Foundation
- Niels Stensen Foundation
- Val A. Browning Foundation
- Arthritis Foundation Alabama Chapter Endowed Chair in Pediatric Rheumatology at the University of Alabama at Birmingham School of Medicine
To examine the safety and efficacy of the interleukin-1 (IL-1) receptor antagonist anakinra as first-line therapy for systemic juvenile idiopathic arthritis (JIA).
Patients with systemic JIA receiving anakinra as part of initial disease-modifying antirheumatic drug (DMARD) therapy were identified from 11 centers in 4 countries. Medical records were abstracted using a standardized instrument, and resulting data were analyzed to characterize concomitant therapies, clinical course, adverse events, and predictors of outcome.
Among 46 patients meeting inclusion criteria, anakinra monotherapy was used in 10 patients (22%), while 67% received corticosteroids and 33% received additional DMARDs. Outcomes were evaluated at a median followup interval of 14.5 months. Fever and rash resolved within 1 month in >95% of patients, while C-reactive protein and ferritin normalized within this interval in >80% of patients. Active arthritis persisted at 1 month in 39% of patients, at 3 months in 27%, and at >6 months of followup in 11%. Approximately 60% of patients, including 8 of 10 receiving anakinra monotherapy, attained a complete response without escalation of therapy. Disease characteristics and treatment were similar in partial and complete responders, except that partial responders were markedly younger at onset (median age 5.2 years versus 10.2 years; P = 0.004). Associated adverse events included documented bacterial infection in 2 patients and hepatitis in 1 patient. Tachyphylaxis was not observed.
Anakinra as first-line therapy for systemic JIA was associated with rapid resolution of systemic symptoms and prevention of refractory arthritis in almost 90% of patients during the interval examined. These results justify further study of IL-1 inhibition as first-line, rather than rescue, therapy in systemic JIA.