Anakinra as a first-line therapy for systemic juvenile idiopathic arthritis when nonsteroidal anti-inflammatory drug treatment fails: A single-center French retrospective study
Authors
Jérôme Granel; Adeline Ravalet; Aseel Daghistani; Johanna Clet; Olivier Richer; Marion Bailhache; Pascal Pillet;
Keywords
Introduction: Anakinra has dramatically improved the management of systemic juvenile idiopathic arthritis (SJIA) over the last decade. Nevertheless, management remains inconsistent; corticosteroids are still frequently used. We analyzed the course of SJIA in children treated with anakinra according to the time of treatment initiation after disease onset.
Method: Children with SJIA treated with anakinra between 2006 and 2020 were included in this single-center, retrospective observational study.
Results: Twenty-four children received anakinra at a median time of 58 (range 12–2940) days after SJIA onset, all after failure of nonsteroidal anti-inflammatory drug (NSAID) treatment. Eighteen were males and the median age at disease onset was 6.04 (range 0.8–13) years. The median follow-up time was 3.5 (range 0.5–10.8) years after treatment initiation. At the last follow-up, remission attributable to anakinra was observed in 18/24 (75%) children and treatment-free remission was observed in 12 (67%). For each child, the response to anakinra was the same at 3 months and at the last follow-up. The 15 children treated with anakinra within the first 3 months after disease onset exhibited better remission (93%) than did the 9 children treated after 3 months (44%) (p = 0.015) and the former received fewer corticosteroids (7% versus 67%) (p = 0.004). One child with long-standing disease died of the disease.
Conclusions: Early anakinra initiation within the first 3 months of SJIA onset after NSAID failure ensures long-term remission and reduces corticosteroid use. Anakinra should not be continued for more than 3 months in nonresponding children.
Jérôme Granel
University Hospital Centre Bordeaux Pellegrin Hospital, Bordeaux, France
Adeline Ravalet
University Hospital Centre Bordeaux Pellegrin Hospital, Bordeaux, France
Aseel Daghistani
University Hospital Centre Bordeaux Pellegrin Hospital, Bordeaux, France
Johanna Clet
University Hospital Centre Bordeaux Pellegrin Hospital, Bordeaux, France
Olivier Richer
University Hospital Centre Bordeaux Pellegrin Hospital, Bordeaux, France
Marion Bailhache
University Hospital Centre Bordeaux Pellegrin Hospital, Bordeaux, France
Pascal Pillet
University Hospital Centre Bordeaux Pellegrin Hospital, Bordeaux, France
University Hospital Centre Bordeaux Pellegrin Hospital, Bordeaux, France
Adeline Ravalet
University Hospital Centre Bordeaux Pellegrin Hospital, Bordeaux, France
Aseel Daghistani
University Hospital Centre Bordeaux Pellegrin Hospital, Bordeaux, France
Johanna Clet
University Hospital Centre Bordeaux Pellegrin Hospital, Bordeaux, France
Olivier Richer
University Hospital Centre Bordeaux Pellegrin Hospital, Bordeaux, France
Marion Bailhache
University Hospital Centre Bordeaux Pellegrin Hospital, Bordeaux, France
Pascal Pillet
University Hospital Centre Bordeaux Pellegrin Hospital, Bordeaux, France