RoActemra (tocilizumab) or IL-1 inhibitors are more effective than Enbrel in managing and promoting remission in patients with juvenile idiopathic arthritis (JIA), according to a study published in the journal Arthritis Research & Therapy.
Treatment of JIA is usually based on administration of steroids and non-steroidal anti-inflammatory drugs (NSAIDs). However, these therapies do not manage disease symptoms very well and have several side effects.
The development of antibodies that can control auto-inflammatory processes, such as RoActemra and interleukins inhibitors, has opened new therapeutic options for these patients. Despite these advances, JIA remains a major therapeutic challenge in pediatric rheumatology.
In the study “Experience with etanercept, tocilizumab and interleukin-1 inhibitors in systemic onset juvenile idiopathic arthritis patients from the BIKER registry,” a team of researchers from Germany evaluated and compared the effectiveness and safety of several biologic therapies available to treat JIA.
The researchers collected information from 245 patients who participated in the German Biologics register (BiKeR) from 2000 to 2015.
Among this group, 143 patients had been treated with Enbrel (etanercept; marketed by Amgen), 71 with RoActemra (marketed by Roche), and 60 received IL-1 inhibitors — Kineret (anakinra; marketed by Sobi) or Ilaris (canakinumab; marketed by Novartis).
All patients underwent treatment with steroids before initiating biologics therapy. In addition to biologics, many patients continued treatment with steroids and methotrexate.
In the Enbrel-treated group, 83 percent received steroids and 88 percent methotrexate; in the RoActemra group, 44 percent were treated with steroids and 83 percent with methotrexate. In the IL-1 inhibitors group, 45 percent of the patients were treated with steroids and 58 percent with methotrexate.
Analysis of treatment response rates revealed that patients who were treated with IL-1 inhibitors or RoActemra for more than two years showed more improvements than those treated with Enbrel.
IL-1 inhibitors and RoActemra also were found to be more effective in inducing disease remission compared to Enbrel.
Juvenile Disease Activity Score (JADAS) lower than 1 – used as measure of disease remission – was achieved in 37 and 52 percent of patients treated with IL-1 inhibitors and RoActemra, respectively. In the Enbrel group, that score was achieved by only 20 percent of the patients.
A similar trend was observed for JADAS lower than 3.8 – a measure of minimal disease activity – with a response rate of 35, 61, and 68 percent for Enbrel, IL-1 inhibitors, and RoActemra, respectively.
Adverse events associated with the treatments were significantly more frequent in patients treated with RoActemra and IL-1 inhibitors than with Enbrel. The most common adverse events reported were infections. However, the researchers said the safety profile regarding infections from these therapies is acceptable.
“Patients with JIA are already at greater risk of bacterial infections leading to hospitalization due to their chronic disease, the high disease burden and the high necessity for concomitant treatment with systemic corticosteroids,” the researchers wrote.
The team emphasized, however, that the effectiveness and safety data should be interpreted with caution, as the Enbrel-treated group had higher rates of concomitant use of disease-modifying antirheumatic drugs and steroids.
Taken together, “the results revealed that a large proportion of patients with sJIA [systemic onset JIA] had a significant response to treatment, especially with TOC [RoActemra] or with IL-1i [IL-1 inhibitors],” the researchers concluded. “ETA [Enbrel] has been used in the past but it is clearly less effective and its use in systemic JIA has markedly decreased in Germany.”