New Study of Juvenile Idiopathic Arthritis Patients Finds Long-Term Biologic Treatments Safe

A new study using ongoing surveillance data of systemic-onset juvenile idiopathic arthritis (JIA, formerly juvenile rheumatoid arthritis) patients collected since 2001 found long-term use of biologic treatments is safe. This variation of JIA (sJIA) comprises about 10 percent of juvenile cases and presents with a variety of systems such as fever, rash, and swelling of organs.

Observing biologic treatment in sJIA patients

The researchers looked at adverse events reports after the first dose of biologics (anakinra, canakinumab, tocilizumab, and etanercept) through 90-days after the last dose of 260 juvenile-onset patients.

What did previous research show?

Previous research suggests that biologics targeting IL-1 (such as anakinra and canakinumab) or IL-6 (tocilizumab) receptors may be the most effective for sJIA patients. In fact, IL-1 blocking is now the recommended consensus treatment by the American College of Rheumatology.

Study results on biologic use in sJIA patients

In this study, patients taking etanercept still experienced high levels of disease activity. Serious adverse events were reported more by patients taking canakinumab and tocilizumab. Additionally, serious infections were experienced more with IL-1 and IL-6 treatments. More adverse events were reported with combination treatment (biologic plus steroids).

Macrophage activation syndrome (a dangerous sJIA complication involving inflammation that enlarges the organs) occurred in all groups, but more frequently with those taking canakinumab and tocilizumab. By adjusting for infection risk with these treatments, only anakinra-treated patients remained high. Additionally, three malignancies were reported and two deaths occurred in patients taking etanercept (though the deaths were determined to be unrelated to the treatment).

Overall tolerance was good

Despite these adverse events, the researchers determined the overall tolerance of biologic treatment for these patients was good.

More effective biologic treatments

Since this study looked at patient treatments over a long period of time, changes in treatment trends were observed. While a majority of patients before 2006 (87%) were taking etanercept, this declined to about 5% after 2013. Presumably, this is due to a change in the variety of biologic treatments available and later research indicating the improved efficacy of other medications targeting IL-1 and IL-6 receptors.

Adverse events with more effective treatments for sJIA patients

One result of note is that while the biologics targeting IL-1 and IL-6 have been previously found to be more effective in treating sJIA patients, in this study they also are found to be linked with adverse events. It is possible the effectiveness of the medications may place patients at risk of other complications. However, even the other types of biologics could present adverse events, so the line is not clear cut.

Long-term safety of biologic treatment: more research needed

Previously, research about long-term safety of biologic treatment has been lacking. This study adds knowledge to the understanding of the impact of long-term treatment for inflammatory diseases with biologic drugs.

Benefits of knowing treatment complications

Since the earliest biologic treatments have now been around for more than 20 years and more patients have been taking them long-term for rheumatoid arthritis and related conditions, it's helpful to know what complications may present so that patients and their doctors can monitor for these issues. It also helps to better understand what treatments may be targeted best for specific conditions.

While biologics are now considered the most effective treatment for a number of inflammatory diseases, patients still largely take them by trial and error or whatever is allowed through their health insurance and financial situation. If we could target treatment through better research and better knowledge of serious complications, disease damage and other costly health issues could be prevented.

 

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