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Anakinra as first-line disease-modifying therapy in systemic juvenile idiopathic arthritis: report of forty-six patients from an international multicenter series.

Publication ,  Journal Article
Nigrovic, PA; Mannion, M; Prince, FHM; Zeft, A; Rabinovich, CE; van Rossum, MAJ; Cortis, E; Pardeo, M; Miettunen, PM; Janow, G; Birmingham, J ...
Published in: Arthritis Rheum
February 2011

OBJECTIVE: 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). METHODS: 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. RESULTS: 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. CONCLUSION: 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.

Duke Scholars

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Published In

Arthritis Rheum

DOI

EISSN

1529-0131

Publication Date

February 2011

Volume

63

Issue

2

Start / End Page

545 / 555

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Male
  • Joints
  • International Cooperation
  • Interleukin 1 Receptor Antagonist Protein
  • Infant
  • Humans
  • Glucocorticoids
  • Female
  • Drug Therapy, Combination
 

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Nigrovic, P. A., Mannion, M., Prince, F. H. M., Zeft, A., Rabinovich, C. E., van Rossum, M. A. J., … 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 Rheum, 63(2), 545–555. https://doi.org/10.1002/art.30128
Nigrovic, Peter A., Melissa Mannion, Femke H. M. Prince, Andrew Zeft, C Egla Rabinovich, Marion A. J. van Rossum, Elisabetta Cortis, et al. “Anakinra as first-line disease-modifying therapy in systemic juvenile idiopathic arthritis: report of forty-six patients from an international multicenter series.Arthritis Rheum 63, no. 2 (February 2011): 545–55. https://doi.org/10.1002/art.30128.
Nigrovic PA, Mannion M, Prince FHM, Zeft A, Rabinovich CE, van Rossum MAJ, et al. Anakinra as first-line disease-modifying therapy in systemic juvenile idiopathic arthritis: report of forty-six patients from an international multicenter series. Arthritis Rheum. 2011 Feb;63(2):545–55.
Nigrovic, Peter A., et al. “Anakinra as first-line disease-modifying therapy in systemic juvenile idiopathic arthritis: report of forty-six patients from an international multicenter series.Arthritis Rheum, vol. 63, no. 2, Feb. 2011, pp. 545–55. Pubmed, doi:10.1002/art.30128.
Nigrovic PA, Mannion M, Prince FHM, Zeft A, Rabinovich CE, van Rossum MAJ, Cortis E, Pardeo M, Miettunen PM, Janow G, Birmingham J, Eggebeen A, Janssen E, Shulman AI, Son MB, Hong S, Jones K, Ilowite NT, Cron RQ, Higgins GC. Anakinra as first-line disease-modifying therapy in systemic juvenile idiopathic arthritis: report of forty-six patients from an international multicenter series. Arthritis Rheum. 2011 Feb;63(2):545–555.
Journal cover image

Published In

Arthritis Rheum

DOI

EISSN

1529-0131

Publication Date

February 2011

Volume

63

Issue

2

Start / End Page

545 / 555

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Male
  • Joints
  • International Cooperation
  • Interleukin 1 Receptor Antagonist Protein
  • Infant
  • Humans
  • Glucocorticoids
  • Female
  • Drug Therapy, Combination