Treatment with Ilaris (canakinumab) can be discontinued without relapse in some children with systemic juvenile arthritis (sJIA), according to a recent small study.
Sustained remission specifically appears to be more likely in children with shorter disease duration and with no history of using a biologic disease-modifying anti-rheumatic drug (DMARD) prior to taking Ilaris.
The study, “Discontinuation of Canakinumab following Clinical Disease Remission Is Feasible in Patients with Systemic Juvenile Idiopathic Arthritis,” was published in the Journal of Rheumatology.
sJIA, which affects only 10% of juvenile arthritis patients, is characterized by arthritis — primarily joint pain and stiffness — recurring fever, and widespread inflammation. Its cause is unknown (idiopathic) and how best to treat it is a major concern for patients, parents, and physicians.
Novartis‘ Ilaris is an antibody that targets interleukin-1 beta (IL-1), an important mediator of the body’s inflammatory response. Blocking IL-1 relieves many of the symptoms of inflammation.
Although Ilaris and several other therapies have proven capable of controlling the symptoms of sJIA, the duration and best timing for stopping treatment remain open questions.
Now, a team from Greece and the U.K. analyzed what happened when children treated with Ilaris were taken off the medication. Their goal was to determine the risk factors associated with disease relapse.
To do so, the researchers collected data from 12 sJIA patients — seven girls, five boys — who had experienced remission (inactive disease) for at least two years while using Ilaris between January 2008 and January 2017.
The children’s median age was 8.5 years, and they had taken Ilaris for a median duration of 2.8 years. All were taking corticosteroids when Ilaris was started, with the steroid use stopped three to nine months later.
Among the 12 patients, 10 also were taking methotrexate, one was given Arava (leflunomide), and one was taking cyclosporine.
Eight children also had received at least one other biologic DMARD before starting Ilaris. Two of the eight had received at least two biologics prior to Ilaris, and one had received three.
The results showed that four patients successfully stopped treatment with Ilaris without experiencing relapse. Three of these children also successfully discontinued methotrexate and remained in remission for more than two years, as of the study’s completion.
Six of the remaining eight patients had to return to Ilaris treatment, while a short course of steroids resolved flare-ups in the remaining two children.
The relapses most commonly occurred within six months of stopping the DMARD therapy; only one of eight children relapsed after a longer period.
In examining the data, the researchers found that patients who were being treated with a biologic for the first time and those who had shorter disease duration showed higher chances of successful remission.
Neither age, sex, nor abruptly versus gradually going off Ilaris affected the clinical outcomes, the research showed.
The researchers said that, despite the low number of patients in the study, the results indicate that Ilaris withdrawal is possible for some children with sJIA.
“Nonetheless, the required period of time in clinical disease remission while receiving canakinumab [Ilaris] treatment prior to attempting discontinuation of the drug is still unclear,” the team said.