Experience of using genetically engineered biological drugs in children with a systemic form of JIA in the Karaganda region

Abstract

Despite all the achievements of science and medicine, juvenile idiopathic arthritis today remains one of the main childhood diseases that lead to severe irreversible consequences. This, in turn, makes it urgent to search for effective drugs for the treatment of juvenile idiopathic arthritis, of which interleukin 1 (anakinra) and interleukin 6 (tocilizumab) inhibitors are becoming increasingly popular. AIM: to analyse the effi cacy of genetically engineered biological drugs, namely anakinra and tocilizumab in children with systemic juvenile idiopathic arthritis among patients of the Karaganda region. The study involved 176 patients aged 4-17 years with a diagnosis of systemic juvenile idiopathic arthritis and with resistance to methotrexate for 3 months. Among all patients, 64 children received injections of anakinra, and 63 received tocilizumab in standard doses. The control group consisted of 50 patients of the same age category. Assessment of the effi cacy of treatment was conducted at 2, 4, 8, 16, 24, and 48 weeks using ACR Pediatric criteria. The clinical effect of both drugs was detected as early as the second week after the start of therapy. At week 12 of the study in the tocilizumab group, the effi cacy of treatment for ACR Pediatric 30, 50, and 70 reached 82 %, 71 %, and 69 %, and in the anakinra group -89 %, 81 %, and 80 % respectively, while in the control group ACR Pediatric 30 after 12 weeks of treatment was achieved in 21 % of patients, ACR Pediatric 50 -in 12 %, and ACR Pediatric 70 -in 9 % (p < 0.001). By the end of the extended open phase, after 48 weeks of the study among patients treated with tocilizumab, the number of patients who reached ACR Pediatric 70 was 85 %. Those who reached ACR Pediatric 90 were 55 %, whereas, in the anakinra group, 89 % reached ACR Pediatric 70 and 61 % -ACR Pediatric 90. Moreover, the clinical effect was accompanied by an improvement in blood parameters, for example, haemoglobin and pro-infl ammatory markers (C-reactive protein, procalcitonin), which indicates the role of interleukin 1 and interleukin 6 in the aetiology of anaemia in juvenile idiopathic arthritis. The use of tocilizumab and anakinra as treatment for systemic juvenile idiopathic arthritis resistant to methotrexate leads to a stable improvement in the general condition of patients (Ref. 36).