Tapering and withdrawal of tocilizumab in patients with systemic juvenile idiopathic arthritis in inactive disease: results from an alternative dosing regimen in the TENDER study

Benedetti, Fabrizio; Ruperto, Nicolino; Brunner, Hermine I.; Grom, A; Wulffraat, NM; Henrickson, Michael; Jerath, Rita; Kimura, Yukiko; Kadva, AK; Wang, J; Martini, Alberto; Lovell, DJ

doi:10.1186/1546-0096-12-s1-o13

Cited by 3 publications

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“…Twenty-six of a total 39 patients remained in clinically inactive disease during tapering, and 9 patients discontinued tocilizumab. 29 In our centre, 12 out of 77 patients (15%) discontinued BA treatment for clinical remission, with 11 being treated with anakinra as the only BA.…”

Section: Discussionmentioning

confidence: 93%

Biological treatment in systemic juvenile idiopathic arthritis: achievement of inactive disease or clinical remission on a first, second or third biological agent

et al. 2015

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ObjectivesTo analyse the effect of biological agents (BAs) in terms of achieving inactive disease (ID) or clinical remission (CR) in patients with systemic juvenile idiopathic arthritis (SJIA), to describe effects of switching or discontinuing a BA and to assess the proportion of patients able to maintain ID or CR off steroids and after withdrawing BA therapy.MethodsRetrospective study in a French paediatric rheumatology reference centre using the CEMARA (CEntre des MAladies RAres) register.ResultsSeventy-seven patients were included with a cumulative follow-up of 245.5 patient-years (median 1.1, range 0.5–8.0). On a first BA, ID was achieved in 37 patients, including 1 patient out of 12 patients on etanercept, 26 patients out of 51 on anakinra and 7 out of 10 on canakinumab. One patient on abatacept and two patients on tocilizumab also achieved ID. Switching of BA was common. The switch to a second (n=34), third (n=18) or fourth (n=4) BA resulted in ID in a further 13 patients, either on canakinumab (n=6) or tocilizumab (n=7). At last follow-up, 40 patients were in CR (27 patients off steroids, 5 patients having never received steroid treatment), either on (n=29) or off (n=11) BA.ConclusionsIn this series of patients with SJIA, interleukin-1 inhibitors were associated with a higher proportion of ID than tumour necrosis factor inhibitors when used as first BA. Switching allowed some patients to achieve ID when treated with canakinumab or tocilizumab. CR was eventually achieved in more than half of the patients.

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Section: Discussionmentioning

confidence: 93%

Biological treatment in systemic juvenile idiopathic arthritis: achievement of inactive disease or clinical remission on a first, second or third biological agent

et al. 2015

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“…Data from the TENDER clinical trial ( N = 112) studied tocilizumab taper in SJIA after 2 years of treatment and CID for 3 months by spacing the infusions from every 2 weeks to 3 weeks then 4 weeks then stopping infusions (35%, n = 39 were eligible for taper). At the time of last data review (May 2014), 7 patients were able to discontinue tocilizumab while 2 patients had to revert back to regular q 2 week doing schedule [13].…”

Section: Discussionmentioning

confidence: 99%

Physician practices for withdrawal of medications in inactive systemic juvenile arthritis, Childhood Arthritis and Rheumatology Research Alliance (CARRA) survey

et al. 2019

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Background We describe a Childhood Arthritis and Rheumatology Research Alliance (CARRA) survey of North American pediatric rheumatologists that assesses physician attitudes on withdrawal of medications in systemic juvenile idiopathic arthritis (SJIA). Methods A REDCap anonymous electronic survey was distributed to 100 random CARRA JIA workgroup physician-voting members. The survey had three broad sections including: A) demographic information; B) physicians’ opinions on clinical inactive disease (CID) in SJIA and C) existing practices for withdrawing medications in SJIA. Results The survey had an 86% response rate. 88 and 93% of participants agreed with the current criteria for CID and clinical remission on medications (CRM) respectively. 78% thought it necessary to meet CRM before tapering medications except steroids. 76% use CARRA SJIA consensus treatment plans always or the majority of the time. All participants weaned steroids first in SJIA patients on combination therapy, 47% waited > 6 months before tapering additional medications. 35% each tapered methotrexate over > 6 months and 2–6 months; however, 39% preferred tapering anakinra, canakinumab and tocilizumab more quickly over 2–6 months and favored spacing the dosing interval for canakinumab and tocilizumab. When patients are on combination therapy with methotrexate and biologics, 58% preferred tapering methotrexate first while others considered patient/family preference and adverse effects to guide their choice. Conclusion Most CARRA members surveyed use published consensus treatment plans for SJIA and agree with validated definitions of CID and CRM. There was agreement with tapering steroids first in SJIA. There was considerable variability with tapering decisions of all other medications. Electronic supplementary material The online version of this article (10.1186/s12969-019-0342-5) contains supplementary material, which is available to authorized users.

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“…had earlier concluded that it might be possible to use tocilizumab at a less frequent dosing schedule (4 weekly) in mild sJIA compared with severe disease (2 weekly schedule) 19 . Even long‐term data from the TENDER trial suggested that a proportion of patients with sJIA who maintain clinically inactive disease status can progressively space out TCZ infusions 20 …”

Section: Discussionmentioning

confidence: 99%

Efficacy and safety of an early response‐based tapering regimen of tocilizumab in children with systemic juvenile idiopathic arthritis

Dey,

Roy,

Sinhamahapatra

et al. 2024

Int J of Rheum Dis

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IntroductionSystemic juvenile idiopathic arthritis (sJIA) is a distinct disease subset, with a poorer prognosis compared with other JIA subsets. Tocilizumab has an important role in the management of sJIA refractory to standard initial therapy. However, no specific guidelines exist for the tapering of tocilizumab therapy in sJIA, which could have implications on the overall cost and side effects of treatment.MethodsThis was an observational study which included 21 children with refractory sJIA, who were initially put on injection tocilizumab every 2 weekly, with subsequent dosing tapered to 4 weekly and 6 weekly intervals based on JIA ACR 70 responses at 12 and 24 weeks, respectively. The primary outcome at week 36 included JIA ACR 30, 50, 70, and 90 response rates with other efficacy and safety measures as secondary outcomes.ResultsAt 36 weeks, JIA ACR 30, 50, 70, and 90 responses were observed in 90.5%, 90.5%, 71.4%, and 52.4% patients respectively along with significant improvement in hematological and inflammatory parameters. The mean prednisolone dose could be reduced from 0.54 to 0.13 mg/kg/day and around 29% patients were able to discontinue steroids altogether. No serious adverse events were recorded. With drug tapering, we could curtail on 26% of the total tocilizumab dose that would have been otherwise required on the continuous 2 weekly protocol.ConclusionsTocilizumab, used in an early response‐based tapering regimen, was both safe and efficacious in children with sJIA refractory to standard therapy. Larger and longer duration studies are required to further validate our observations.

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Tapering and withdrawal of tocilizumab in patients with systemic juvenile idiopathic arthritis in inactive disease: results from an alternative dosing regimen in the TENDER study

Cited by 3 publications

References 0 publications

Biological treatment in systemic juvenile idiopathic arthritis: achievement of inactive disease or clinical remission on a first, second or third biological agent

Biological treatment in systemic juvenile idiopathic arthritis: achievement of inactive disease or clinical remission on a first, second or third biological agent

Physician practices for withdrawal of medications in inactive systemic juvenile arthritis, Childhood Arthritis and Rheumatology Research Alliance (CARRA) survey

Efficacy and safety of an early response‐based tapering regimen of tocilizumab in children with systemic juvenile idiopathic arthritis

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