The Effect Of Tocilizumab In Systemic JIA

Objective:To observe the effect and adverse reactions of humanized anti-IL-6 receptor monoclonal antibody—tocilizumab in systemic JIA.Methods:We choose 22 children,2 to 9.5 years of age, inadequate responses to NSAIDs or glucocorticoid dependent active systemic JIA., according to the ratio of 1:1 randomly assigned to two groups. The observation group received tocilizumab(biweekly doses of 8mg/Kg for patients who weight≥30 kg and 12mg/Kg for patients who weight<30 kg) combined NSAIDs and(or) glucocorticoid. The control group received glucocorticoid(prednisone:1.0-1.5mg/Kg-d) combine NSAIDs. Evaluate the effect by The Juvenile Arthritis Disease Activity Score 27(JADAS27) at 6 week and 12 week.Results:At 6 and 12 week, the symptoms(fever, rash, arthritis) and the inflammation makers of both groups were improved. At 6 week, there were 4 patients (36.3%) achieved inacitive disease standards in observation group and 1 patient(9.1%) in coutrol group, at 12 week,4 patients (36.3%) achieved inacitive disease standards in both groups. We have found statistical difference(P<0.05) in JADAS27 of the observation group at the beginning of therapy and after 6,12 weeks. There was statistical difference(P<0.05) in JADAS27 of the control group at the beginning of therapy and after 6 weeks, no significant difference at the the beginning of therapy and after 12 weeks. Both groups had no significant difference in remission of JADAS27 at the treatment of 6 and 12 weeks. The ESR were significant decreased(P<0.05) in the experiment group at the treatment of 12 weeks and in the control group at the treatment of 6 weeks. Both groups had no significant difference in decrease of ESR at the treatment of 6 and 12 weeks. There was no statistical difference(P>0.05) in CRP of the both groups at the beginning of therapy and after 6,12 weeks. At the treatment of 6 weeks, the decrease of CRP in control group was more than the experiment group(P<0.05), and at 12 weeks, both groups had no significant difference in decrease of ESR(P>0.05).The adverse events of tocilizumab is common, include infection, rash, and increased aminotransferase levels.Conclusion:Tocilizumab was efficacious in inadequate responses to NSAIDs and glucocorticoid dependent systemic JIA. Tocilizumab is with rapid onset and certain effect in short-term. But we should note the adverse events, included infection, rash, and increased aminotransferase levels.