Extremely positive results have just been announced from a 5-year follow-up study of a systemic juvenile idiopathic arthritis (sJIA) treatment called Kineret. This treatment has been approved for use in sJIA patients who are at least 8 months old in the European Union. Unfortunately, in the United States it is currently only approved for Rheumatoid Arthritis and cryopyrin-associated periodic syndromes.
Kineret is an immunosuppressent which blocks the inflammatory signals sent by IL-1. It was initially studied in sJIA by researchers in the Netherlands at the University Medical Centre Utrecht. As positive results were evident after 32 months, a long-term study was initiated. This study was planned to span five years. Results from this study have just been published in Arthritis and Rheumatology.
This trial included 42 participants who had a median age of 7. Most patients had been recently diagnosed with sJIA and had unfortunately not responded to non-steroid anti-inflammatory drugs. The trial also included people who were suspected of having the condition, but who did not have all of the signs of arthritis.
The ultimate goal of this study was to determine whether the prescription of Kineret could reduce the need of glucocorticoids. While effective, these drugs are often accompanied with harmful side effects and therefore their longterm use is not ideal.
All of the patients were given up to 200mg of Kineret each day. If the disease persisted, either prednisone was added to the therapeutic regime (57.1% of patients) or patients were switched to canakinumab or tocilizumab (33% of patients). On average, after just 33 days of receiving Kineret, patients reached inactive disease. Patients who reached inactive disease by 3 months were slowly tapered off the treatment. Some participants experienced flares after stopping the treatment, but for these individuals Kineret was re-initiated and the flareup was subsequently stopped.
One Month: Disease activity stopped in 55% of patients.
First Year: Disease inactive in 76% of patients. 52% of the patients had inactive disease and no longer needed medication.
Three Years: Out of 35 patients in a follow-up examination, 95% had inactive disease.
Five Years: Out of 25 patients in a follow-up examination, 95% had inactive disease. 72% of patients had inactive disease and no longer needed medication.
Three patients in this evaluation did stop the treatment because they were not responding to therapy and had also developed macrophage activation symptom.
Overall, a high number of neutrophils before treatment and reaching inactive disease after one month on Kineret were found to be predictors that patients would still have inactive disease after one year on the therapy. The concluding statement from researchers was that for the majority of sJIA patients, treatment with Kineret not only brings a state of inactive disease quickly, but that this state is sustained. Additionally, Kineret is effectively able to reduce the need for glucocorticiod use.
Ultimately, Kineret minimizes patients experience of disease related or therapy related long-term damage.
Perhaps this study will lead to further investigation of Kineret in sJIA in the United States.
You can read more about this five-year follow-up study here.