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Canakinumab For Systemic Juvenile Idiopathic Arthritis

Natan Rosenfeld Natan Rosenfeld April 26, 2021
Medically reviewed by Susan Kerrigan, MD and Marianne Madsen

Juvenile idiopathic arthritis (JIA) is a type of autoimmune arthritis that affects children and teenagers below the age of 16. It’s a rare disease; only 294,000 American children live with the condition. But even more uncommon is systemic juvenile idiopathic arthritis (SJIA), a “subtype” of JIA. Only 10 to 20 percent of kids with JIA suffer from SJIA. SJIA is the most severe form of JIA, characterised by severe arthritis, fever, skin rash, lymph nodes enlargement, and enlargement of the spleen and the liver. It can have life-threatening complications.

 

There are limited treatment options for SJIA. But there is hope for systemic juvenile idiopathic arthritis sufferers: a drug called canakinumab has shown promising results in relieving symptoms of the condition.

 

The study

 

A recent study published in Arthritis and Rheumatology tested canakinumab on SJIA patients. One hundred twenty-three children and adolescents participated in the study. As fever is often a key symptom of SJIA, researchers wanted to determine if the drug could effectively treat patients both with and without fever. So they selected a number of patients from both categories: 70 (with fever) and 52 (without fever). (Fever was undetermined in one subject.) 

All 123 participants received a subcutaneous dose of 4 mg/kg of canakinumab every 4 weeks over the course of nearly two years. Only 84 participants (68%) continued until the end of the study period.

 

The researchers gauged the effectiveness of the drug using a modified set of American College of Rheumatology criteria as well as the widely accepted Juvenile Arthritis Disease Activity Score (JADAS). Both of these criteria measure how active the arthritis  is in a patient.

 

Reduced symptoms in two weeks

 

After only 15 days of canakinumab treatment, both groups of participants (with and without fever) showed improvement in symptoms. As the study continued its course, participants’ symptoms continued to diminish. After six months, the drug had been effective in reducing symptoms in patients with and without fever–meeting both sets of the outcome criteria.

 

The study concluded that “canakinumab provided rapid and sustained improvement of active SJIA irrespective of the presence of fever at treatment initiation.”

Both safe and effective

 

The study’s lead author, Hermine I. Brunner, MD, of the Cincinnati Children’s Hospital Medical Center, wrote that “canakinumab demonstrated fast onset of action in SJIA” and that the drug has “a well-characterized long-term safety profile,” meaning that canakinumab has potential value as a future treatment option for SJIA sufferers. Based on multiple other clinical trials, canakinumab has received FDA approval for use in SJIA. 

 

In addition, Brunner and her team wrote that patients who respond particularly well to the treatment could even be tapered off the drug entirely, although only 10.6% were able to reduce their dose to 2 mg/kg. 

 

“Sustained canakinumab tapering could be obtained in a minority of patients with well-controlled disease activity and at least 6 months after canakinumab initiation,” the team wrote.

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