Tacrolimus, an investigational immunosuppressive treatment, may be an effective therapeutic option for children and adolescents with systemic-onset juvenile idiopathic arthritis (SOJIA), a study says.
The study, “Treatment of patients with systemic‑onset juvenile idiopathic arthritis with tacrolimus,” was published in Experimental and Therapeutic Medicine.
SOJIA is a severe form of juvenile idiopathic arthritis (JIA) characterized by recurrent fever episodes and the presence of a pink skin rash that can appear anywhere on the abdomen, arms, or legs.
Tacrolimus is an immunosuppressive agent that blocks the activation of the IL-2 gene, as well as the production of other pro-inflammatory molecules, including tumor necrosis factor-alpha (TNF-α), interleukin-1-beta (IL-1β), and interleukin-6 (IL-6).
Patients who undergo transplantation use tacrolimus to decrease the odds of transplant rejection. Tacrolimus has also been used in the treatment of autoimmune diseases, such as refractory nephrotic syndrome, lupus nephritis, and rheumatoid arthritis. However, few studies have evaluated the therapeutic potential of tacrolimus in children with SOJIA.
Therefore, researchers from the Children’s Hospital of Fudan University in China sought to analyze the therapeutic effects of tacrolimus in a group of six patients with SOJIA. Study participants (three girls and three boys under 18) were evaluated before starting tacrolimus treatment (baseline), and at six months and one year after treatment (last follow-up visit).
Clinical data was gathered retrospectively by analyzing patients’ medical records and included sex, age, disease duration, tacrolimus dose, erythrocyte sedimentation rate (the rate at which red blood cells start forming clots), C-reactive protein (a protein whose levels increase in response to inflammation), hemoglobin (protein involved in blood oxygen transport), platelet and white blood cell levels, prednisolone dose, and IL-6 expression.
Results showed that after one year of treatment with tacrolimus (1.0 to 3.0 mg/day), there were significant decreases in the erythrocyte sedimentation rate and the levels of C-reactive protein, platelets, and white blood cells. However, the levels of hemoglobin increased after six months of treatment, and then decreased again one year after the beginning of the study.
As expected, the expression levels of IL-6 also decreased after one year of treatment with tacrolimus compared to baseline, indicating that the therapy successfully reduced tissue inflammation.
In addition, the doses of prednisolone required to manage patients’ symptoms decreased significantly after one year of treatment with tacrolimus, compared with baseline values. No serious side effects were reported over the course of the study.
The mechanism by which tacrolimus effectively ameliorates SOJIA requires further investigation, the researchers noted.
They concluded that tacrolimus “may be an effective treatment strategy for patients with SOJIA. However, the current study was performed at a single center. Therefore, further multicenter and prospective studies with a larger number of patients are required.”