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Chinese Journal of Clinical Pharmacology and Therapeutics ›› 2019, Vol. 24 ›› Issue (12): 1421-1427.doi: 10.12092/j.issn.1009-2501.2019.12.015

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Clinical observation of tocilizumab and etanercept for polyarticular course juvenile idiopathic arthritis

ZOU Lixia, LU Meiping, XU Yiping, ZHENG Qi, ZHENG Rongjun   

  1. Department of Rheumatology and Immunology, Children's Hospital of Zhejiang University Medical School, National Clinical Research Center for Child Health,Hangzhou 310003, Zhejiang, China
  • Received:2019-06-18 Revised:2019-09-24 Online:2019-12-26 Published:2020-01-07

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Abstract:

AIM: To observe and evaluate the clinical effect, immunomodulatory and safety of the tocilizumab and etanercept for patients with polyarticular juvenile idiopathic arthritis（pJIA). METHODS: Twenty-four pJIA patients of high disease activity were admitted from January 2017 to March 2019.All patients were divided into the tocilizumab group(12 cases)and the etanercept group(12 cases).Improvements of clinical symptoms, laboratory parameters and adverse reactions were evaluated and compared between these two groups at pretherapy and 3,6,12 months after the primary treatment. RESULTS:Compared with before treatment, the number of joint swelling, joint tenderness or pain during movement, C-reactive protein (CRP),erythrocyte sedimentation rate (ESR) and JADAS 27 scores in the tocilizumab group and the etanercept group were significantly improved (P<0.05) at 3 months after treatment. Moreover, CRP, ESR and JADAS 27 scores of the tocilizumab group decreased more significantly than those of the etanercept group (P<0.05).Compared with before treatment, the proportion of CD19+B and CD4+T cells, the decrease of IgG, IgA, IgM, C3, C4 and the proportion of CD8+T cells in the tocilizumab group were statistically significantat 6 months after treatment; IgG and IgA in the etanercept group were significantly lower than before treatment; IgG, IgA, IgM, C3, and C4 in the tocilizumab group were significantly lower than those of the etanercept group (P<0.05). At 12 months of treatment, the low disease activity rates of JADAS 27 in the tocilizumab group and the etanercept group were 36.4% and 37.5%, respectively; the ACR Pedi 30/50/70/90 in the two groups reached 100%/100%/87.5%/62.5% and 100%/100%/81.9%/45.5% relief. The most common adverse reaction was infection; meanwhile no significant adverse event happened. CONCLUSION:Tocilizumab and etanercept are effective for pJIA. Tocilizumab can quickly reduce the inflammatory parameters, improve disease activity, and regulate CD4+ T,CD19+ B cells.

Key words: polyarticular course juvenile idiopathic arthritis, tocilizumab, etanercept, lymphocyte subsets, efficacy

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