Anakinra in Systemic Juvenile Idiopathic Arthritis
Molly Miloslavsky
Eli Miloslavsky
A Multicentre, Randomised, Double-Blind, Placebo-Controlled Trial With the Interleukin-1 Receptor Antagonist Anakinra in Patients With Systemic-Onset Juvenile Idiopathic Arthritis (ANAJIS Trial)
Quartier P, Allantaz F, Cimaz R, et al. Ann Rheum Dis. 2011;70(5):747–754
Background
Systemic juvenile idiopathic arthritis (SJIA) is characterized by arthritis, fevers, rash, and hepatosplenomegaly. Treatment options include nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids, methotrexate, and anti-tumor necrosis factor agents, but some patients do not respond adequately. Insufficient treatment may lead to joint damage, macrophage activation syndrome, amyloidosis, and adverse effects from corticosteroids. There was evidence that interleukin-1 (IL-1) played an important role in the pathogenesis of SJIA; however, only several small case series demonstrated benefits of IL-1 blockade.
Objectives
To assess the efficacy of anakinra in treating patients with corticosteroid-dependent SJIA.
Methods
Double-blind, randomized, placebo-controlled trial at 6 centers in France and the US.
Patients
24 patients ages 2 to 20 with SJIA for ≥6 months and active disease. Select exclusion criteria: prior anti–IL-1 treatment.
Intervention
Patients were randomized to receive anakinra 2 mg/kg/d (up to 100 mg) or placebo. Other immunosuppressive agents were discontinued. After 1 month, all patients could receive open-label anakinra and were followed for 12 months.
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