During 2013, there was a lot of news regarding the treatment of juvenile idiopathic arthritis (JIA). But navigating the news – and understanding the research – can be complicated and time-consuming, particularly when you’re caring for a child with arthritis. We asked pediatric rheumatology experts how new drug approvals, advances in drug delivery and other treatment-related news could impact your child’s outcome and care.
“There is a great deal of excitement regarding a wide spectrum of juvenile arthritis treatments that are helping more and more children with JA have improvement and experience remission of their disease,” says Ann Reed, MD, chair of the department of pediatrics and adolescent medicine at the Mayo Clinic, Rochester, Minn.
Here’s what you need to know.
A Boom for Biologics
Biologics continue to have a meaningful impact for many kids with juvenile arthritis. In 2013, the U.S. Food and Drug Administration approved two biologics for children with JIA and studies involving a third have shown promise.
• Canakinumab (Ilaris) is the first biologic to be approved specifically for kids with active systemic JIA (sJIA), an uncommon but especially severe form of childhood arthritis. Canakinumab blocks interleukin-1 (IL-1), a protein that helps trigger inflammation. The drug’s May 2013 approval came after studies involving sJIA patients aged 2 to 19 showed significant symptom improvement in most of those who took the drug. "To have effective therapies that control systemic features is a huge breakthrough,” says Daniel Lovell, MD, associate director of the division of rheumatology at Cincinnati Children's Hospital Medical Center and professor of pediatrics at the University of Cincinnati in Ohio. “Despite advances [in treatment] for other types of JIA, we really don't have good treatments for sJIA, the form that is most severe and associated with the highest mortality."
• Tocilizumab (Actemra) received FDA approval in 2013 for kids with polyarticular JIA. (It was already approved for kids with sJIA and adults with rheumatoid arthritis [RA].) It blocks an inflammation-provoking protein called interleukin-6 (IL-6). How will this new drug fit into your child’s treatment regimen? Some pediatric rheumatologists say the verdict is still out. “Most pediatric rheumatologists will continue to use tumor necrosis factor (TNF) inhibitors as the first-line biologic treatment for JIA, because of their years of experience and comfort with them. But tocilizumab is definitely an option for a child whose arthritis does not improve enough with TNF inhibitors. “The overall impact of tocilizumab on the treatment of polyarticular JIA, in general, may not be huge, but for the individual child who is not doing well with the other biologics, it could be life changing,” says Timothy Beukelman, MD, a pediatric rheumatologist and associate professor of pediatrics in the division of rheumatology at the University of Alabama at Birmingham School of Medicine.
• Rilonacept (Arcalyst) is another drug that blocks IL-1. Research presented in 2013 showed that, for kids with sJIA, it works and it is relatively safe. But, it is experimental and not approved by the FDA as of January 2014. Dr. Beukelman says “despite being effective and safe, rilonacept is unlikely to have a huge impact on the overall treatment of sJIA in the near future, because it does not appear to be significantly different from the currently available IL-1 inhibitors,” which include canakinumab (Ilaris). A potential drawback for this drug: Rilonacept is a weekly injection, instead of a monthly one like canakinumab. That means more frequent shots for your child.