Mod Rheumatol. 2014 Jul;24(4):567-71.

Effect of tocilizumab on growth impairment in systemic juvenile idiopathic arthritis with long-term corticosteroid therapy.

Miyamae T, Yokoya S, Yamanaka H, Yokota S.

Department of Pediatrics, Yokohama City University , Yokohama , Japan.



BACKGROUND: The safety and efficacy of tocilizumab (TCZ), an anti-IL-6 receptor monoclonal antibody, have been reported in the treatment of children with systemic juvenile idiopathic arthritis (sJIA).

OBJECTIVES: Growth of children during the TCZ study was analyzed.

METHODS: Forty-five sJIA patients (8.1 ± 4.2 years) were enrolled. Mean standard deviation score (SDS) for height (HTSDS), height velocity (HVSDS) and changes in SDS from baseline (∆SDS) were determined. Correlation between ∆SDS and several factors such as age, disease duration and corticosteroid exposure were evaluated. Yearly height velocity was analyzed for 28 patients for whom we had data for 1 year prior to TCZ administration and who had received TCZ for more than 1 year.

RESULTS: Of the 45 patients, 38 (84%) obtained a clinical response at week 144. The mean baseline HTSDS was – 2.7 ± 2.0 and inversely correlated with disease duration. Significant improvement was seen in change in HVSDS from 1 year prior to 1 year after baseline (- 6.0 ± 4.0 to – 2.5 ± 3.9, p = 0.0064). Reduction in corticosteroid exposure was significantly associated with improvement in HVSDS (p = 0.0027).

CONCLUSIONS: Growth impairment evidenced by HTSDS was more prominent in patients with longer standing disease. Catch-up growth was observed in patients who required less or no corticosteroid during TCZ treatment.

KEYWORDS: Growth impairment; IL-6; JIA; Tocilizumab

PMID: 24252004

FIgure 1Figure 1: Change in height velocity SDS and relationship with other factors (n=28) . Only reduction in corticosteroid exposure after initiation of TCZ treatment was associated with improvement in height velocity

Figure 2Figure 2: Mean HVSDS and corticosteroid dose over 3 years of TCZ treatment (n=17). In the extension study over 3 years of TCZ treatment, HVSDS was shown to have become standardized by the third year of treatment


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