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VERSAILLES, FRANCE — Anakinra (Kineret) is effective against systemic-onset juvenile idiopathic arthritis, Marilynn Punaro, M.D., reported at the annual scientific meeting of the European Pediatric Rheumatology Congress.
Twelve of 13 children treated at Texas Scottish Rite Hospital for Children in Dallas responded to anakinra, an interleukin-1 receptor antagonist, according to a retrospective chart review presented by Dr. Punaro of the University of Texas Southwestern Medical School at Dallas.
Fever resolved immediately in most cases. Arthritis symptoms improved more slowly, but Dr. Punaro reported they had largely abated at an average follow-up of 14 months.
Eight children had complete sustained responses, she said. Two children, described as “substantially improved,” had partial sustained responses. Dr. Punaro noted that one went from active involvement of 34 joints to just two active joints.
Two others, who had complete transient responses, flared after infections. Only one child, described as “the most persistently active patient,” did not benefit and has been taken off drug for lack of efficacy.
The children, nine girls and four boys, ranged in age from 2 to 17 years when they started on anakinra. Their average duration of disease was 44 months, with a range of 1–142 months. Four were having flares at the initiation of anakinra, according to Dr. Punaro.
Before anakinra therapy, most patients were taking other agents, including corticosteroid, intravenous methylprednisone and/or methotrexate. Two children discontinued infliximab when they started on anakinra.
After anakinra, none of the children continued intravenous methylprednisone, according to Dr. Punaro. Physicians were able to taper the doses of all 11 children on corticosteroids.
While injection site complaints were common, she said infections were a major problem. These include three cases of upper respiratory tract infections, two of influenza, and one each of gastroenteritis, staphylococcus skin infection, and possible sepsis. Dr. Punaro noted that most patients continued on anakinra during infections against medical advice.
She said side effects did not increase with dose increases in children who did not respond initially. “The real question here is, what is the dose?” she said. “Nobody knows the answer to that.”
Microarray analyses showed a direct correlation between degree of clinical and genetic responses, Dr. Punaro added. She showed microarrays for three complete responders in which a genetic signature for systemic-onset juvenile idiopathic arthritis was virtually suppressed. Changes in gene expression were less dramatic by comparison in children with lesser responses.
“These are very preliminary data, but they suggest that [anakinra] may be useful,” she said.
VERSAILLES, FRANCE — Anakinra (Kineret) is effective against systemic-onset juvenile idiopathic arthritis, Marilynn Punaro, M.D., reported at the annual scientific meeting of the European Pediatric Rheumatology Congress.
Twelve of 13 children treated at Texas Scottish Rite Hospital for Children in Dallas responded to anakinra, an interleukin-1 receptor antagonist, according to a retrospective chart review presented by Dr. Punaro of the University of Texas Southwestern Medical School at Dallas.
Fever resolved immediately in most cases. Arthritis symptoms improved more slowly, but Dr. Punaro reported they had largely abated at an average follow-up of 14 months.
Eight children had complete sustained responses, she said. Two children, described as “substantially improved,” had partial sustained responses. Dr. Punaro noted that one went from active involvement of 34 joints to just two active joints.
Two others, who had complete transient responses, flared after infections. Only one child, described as “the most persistently active patient,” did not benefit and has been taken off drug for lack of efficacy.
The children, nine girls and four boys, ranged in age from 2 to 17 years when they started on anakinra. Their average duration of disease was 44 months, with a range of 1–142 months. Four were having flares at the initiation of anakinra, according to Dr. Punaro.
Before anakinra therapy, most patients were taking other agents, including corticosteroid, intravenous methylprednisone and/or methotrexate. Two children discontinued infliximab when they started on anakinra.
After anakinra, none of the children continued intravenous methylprednisone, according to Dr. Punaro. Physicians were able to taper the doses of all 11 children on corticosteroids.
While injection site complaints were common, she said infections were a major problem. These include three cases of upper respiratory tract infections, two of influenza, and one each of gastroenteritis, staphylococcus skin infection, and possible sepsis. Dr. Punaro noted that most patients continued on anakinra during infections against medical advice.
She said side effects did not increase with dose increases in children who did not respond initially. “The real question here is, what is the dose?” she said. “Nobody knows the answer to that.”
Microarray analyses showed a direct correlation between degree of clinical and genetic responses, Dr. Punaro added. She showed microarrays for three complete responders in which a genetic signature for systemic-onset juvenile idiopathic arthritis was virtually suppressed. Changes in gene expression were less dramatic by comparison in children with lesser responses.
“These are very preliminary data, but they suggest that [anakinra] may be useful,” she said.
VERSAILLES, FRANCE — Anakinra (Kineret) is effective against systemic-onset juvenile idiopathic arthritis, Marilynn Punaro, M.D., reported at the annual scientific meeting of the European Pediatric Rheumatology Congress.
Twelve of 13 children treated at Texas Scottish Rite Hospital for Children in Dallas responded to anakinra, an interleukin-1 receptor antagonist, according to a retrospective chart review presented by Dr. Punaro of the University of Texas Southwestern Medical School at Dallas.
Fever resolved immediately in most cases. Arthritis symptoms improved more slowly, but Dr. Punaro reported they had largely abated at an average follow-up of 14 months.
Eight children had complete sustained responses, she said. Two children, described as “substantially improved,” had partial sustained responses. Dr. Punaro noted that one went from active involvement of 34 joints to just two active joints.
Two others, who had complete transient responses, flared after infections. Only one child, described as “the most persistently active patient,” did not benefit and has been taken off drug for lack of efficacy.
The children, nine girls and four boys, ranged in age from 2 to 17 years when they started on anakinra. Their average duration of disease was 44 months, with a range of 1–142 months. Four were having flares at the initiation of anakinra, according to Dr. Punaro.
Before anakinra therapy, most patients were taking other agents, including corticosteroid, intravenous methylprednisone and/or methotrexate. Two children discontinued infliximab when they started on anakinra.
After anakinra, none of the children continued intravenous methylprednisone, according to Dr. Punaro. Physicians were able to taper the doses of all 11 children on corticosteroids.
While injection site complaints were common, she said infections were a major problem. These include three cases of upper respiratory tract infections, two of influenza, and one each of gastroenteritis, staphylococcus skin infection, and possible sepsis. Dr. Punaro noted that most patients continued on anakinra during infections against medical advice.
She said side effects did not increase with dose increases in children who did not respond initially. “The real question here is, what is the dose?” she said. “Nobody knows the answer to that.”
Microarray analyses showed a direct correlation between degree of clinical and genetic responses, Dr. Punaro added. She showed microarrays for three complete responders in which a genetic signature for systemic-onset juvenile idiopathic arthritis was virtually suppressed. Changes in gene expression were less dramatic by comparison in children with lesser responses.
“These are very preliminary data, but they suggest that [anakinra] may be useful,” she said.