Effet of tocilizumab, tumor necrosis factor α inhibitors and disease-modifying anti-rheumatic drugs treating systemic-onset juvenile idiopathic arthritis
Liang Fangfang
Peng Cheng
Luo Shuli
Li Yongbai
Yang Jun
Abstract：Objective To analyze clinical effect of tocilizumab,tumor necrosis factor α (TNF-α)inhibitors and disease-modifying anti-rheumatic drugs (DMARDs) on systemic-onset juvenile idiopathic arthritis (SoJIA).Methods Totally 30 children with SoJIA from December 2013 to December 2015 in Shenzhen Children's Hospital were randomly divided into tocilizumab group(10 cases),TNF-o inhibitors group(10 cases)and DMARDs group(10 cases).The tocilizumab group was treated with tocilizumab and methotrexate;the TNF-α inhibitors group was treated with TNF-α inhibitors and methotrexate;the DMARDs group was treated with DMARDs and glucocorticoid or non-steroidal anti-inflammatory drugs.After 3 and 6 months of treatment,joint pain index,joint swelling index,recurrent fever time and erythrocyte sedimentation rate (ESR),C-reactive protein (CRP),serum ferritin(SF),American College of Rheumatology(ACR) 30 improvement rate and ACR 50 improvement rate were analyzed.Adverse reactions were observed.Results After 3 and 6 months of treatment,joint pain indexes,joint swelling indexes,recurrent fever times and levels of ESR,CRP,SF were all significantly lower than those before treatment in 3 groups [DMARD group:(2.19 ± 0.22),(1.39 ± 0.42) scores vs (2.45 ± 0.21)scores;(2.5±0.5),(2.0±0.3)scores vs (3.5±0.3)scores;(2.67±0.21),(2.06±0.33)months vs (3.78 ± 1.65)months;(61 ± 15),(45 ± 12) mm/1 h vs (84 ± 17) mm/1 h;(69 ± 10),(44 ± 14)mg/L vs (85 ±17)mg/L;(866 ±265),(639 ±96)mg/L vs (2 522 ± 1 686) mg/L;TNF-α inhibitor group:(1.83 ±0.35),(1.02 ± 0.17) scores vs (2.34 ± 0.26) scores;(2.0 ± 0.5),(1.5 ± 0.3) scores vs (3.3 ± 0.3) scores;(1.53±0.36),(1.62±0.24)months vs (3.66 ±1.52)months;(44±12),(34±9)mm/1 h vs (82±19)mm/1 h;(54±15),(30 ± 11) mg/L vs (87 ± 19) mg/L;(574 ± 164),(464 ± 81)mg/L vs (2 496 ±1 826) mg/L;Tocilizumab group:(1.65 ± 0.34),(0.74 ± 0.20) scores vs (2.23 ± 0.25) scores;(1.6 ± 0.4),(0.8 ± 0.5) scores vs (3.4 ± 0.4) scores;(1.63 ± 0.27),(0.80 ± 0.29) months vs (3.56 ± 1.76) months;(40 ± 13),(24± 10)mm/1 h vs (84 ± 19)mm/1 h;(49 ± 12),(15 ± 8)mg/L vs (87 ± 18)mg/L;(478 ±168),(273 ± 62) mg/L vs (2 563 ± 1 765) mg/L] (P ＜ 0.05).After 6 months of treatment,joint pain index,swelling index,recurrent fever time and ESR,CRP,SF levels in tocilizumab group were significantly better than those in TNF-α inhibitors group and DMARDs group (P ＜ 0.05);ACR 30 and ACR 50 improvement rates in tocilizumab group and TNF-α inhibitors group were significantly higher than those in DMARDs group,and ACR 30and ACR 50 improvement rates in tocilizumab group were significantly higher than those in TNF-α inhibitors group (P ＜ 0.05).All adverse reactions were mild-to-moderate and transient,including 1 case of infusion reaction in tocilizumab group,1 case of acute upper respiratory tract infection and 1 case of injection site pain in TNF-αinhibitors group,and 3 cases of gastrointestinal reaction in DMARDs group;adverse reactions were improved after symptomatic treatments.Conclusion In the treatment of SoJIA,tocilizumab is more effective and safer than TNF-α inhibitors and DMARDs.
Keywords：Systemic-onset juvenile idiopathic arthritisTocilizumabTumor necrosis factor-α inhibitorDisease-modifying anti-rheumatic drugs
Publication Date：2016-01-01
Online Publishing Date：2026-09-14(First online date of this platform, not the publication date of the document)
Pages：5( 1338-1342 )