Efficacy And Safety Of Totilizumab In Treatment Of Refractory Systemic Juvenile Idiopathic Arthritis

ObjectiveTo evaluate the efficacy and safety of tocilizumab in the treatment of refractory systemic juvenile idiopathic arthritis.MethodsIn this prospective self-control study,thirty-one children with refractory systemic juvenile idiopathic arthritis were treated with tocilizumab(weight <30 Kg,according to 12 mg/Kg;body weight ≥30 Kg,8 mg/Kg,maximum dose 800 mg,intravenous drip).Observe the change of clinical symptoms before treatment,3 days,2 weeks,4 weeks,8 weeks,16 weeks,and 24 weeks after treatment.Laboratory indicators such as leukocyte,hemoglobin,platelet,and ESR、C-reactive protein(CRP),lactate dehydrogenase,serum protein,the change of hormone dosage and adverse reactions were recorded.Data were analyzed using analysis of variance with repeated measures,and comparisons between groups were performed using least significant differences(LSD).ResultsCompared with before treatment,white blood cells,ESR,and CRP,decreased significantly(P<0.05)after 3 days treatment with tocilizumab,and 28 cases had moderate fever before treatment.Thirteen patients had skin rashes.Three days after the treatment,25 cases had hot regression.About one week after the treatment,the rash disappeared as the body temperature decreased.Two weeks after the treatment,swelling joints and tender joints improved significantly,hemoglobin increased,and platelets decreased(P<0.05);at the 2nd week after treatment,26 cases of ESR and CRP decreased to normal range in 31 cases,2 cases of 12 weeks,1 case of 24 weeks fell to normal range,and ESR and CRP decreased in 2 cases.However,it did not return to normal and rose again;at the 4th week after treatment,ACR Pedi reached 30 or more to 100%;at the 24 th week after treatment,12 of the 31 patients achieved ACR Pedi 90(42%).ConclusionTocilizumab can quickly control the inflammatory response of sJIA,relieve systemic symptoms and joint symptoms,reduce the amount of hormones,and have good safety.