THE USE OF TOCILIZUMAB IN PATIENTS WITH JUVENILE IDIOPATHIC ARTHRITIS IN REPUBLIC OF KAZAKHSTAN
Objective. Identify the factors associated with the level of therapeutic response and safe use of tocilizumab in children with juvenile idiopathic arthritis. Material and methods. The children with juvenile idiopathic arthritis (JIA) and getting the treatment with tocilizumab in the form of intravenous infusion, have been examined (n = 117) from January 2011 to March 2018. The efficacy was assessed according to ACRpedi criteria (Pediatric criteria of American College of Rheumatology). Results and discussion. Use of tocilizumab has shown a quick positive effect in all patients. Fever was arrested after the first infusion in 96% patients with systemic juvenile idiopathic arthritis, cutaneous syndrome was stopped in 12 weeks in 85% of patients, articular syndrome was arrested in 6 months. In patients with a polyarticular form of JIA, 11 patients (30%) reached the stage of inactive disease at the end of 12 weeks of therapy with tocilizumab (according to the C. Wallace criteria, 2004), and 26 patients (72%) after 6 months. It is necessary to point out that if there are factors of poor prognosis (duration of a disease more than 3 years, earlier formation of polyarthritis), the tocilizumab should be prescribed on earlier stages of JIA. Conclusion. The initial positive response to therapy with tocilizumab was registered in 100% of patients. According to the results of seven years observation, 77 patients with a response of more than 50% according to pediatric criteria of the American College of Rheumatology continue the therapy. Steady improvement allowed to reduce the dose of glucocorticoids in all patients and to cancel it in 78%, to discontinue non-steroidal anti-inflammatory drugs in 64% of patients. At the time of completion of the study, 92% of patients had the status of an inactive disease. A lower response to therapy was observed in patients with a longer duration of the disease, at the time of initiation of therapy with tocilizumab. The most frequent adverse events were neutropenia and infusion allergic reactions. The causes of tocilizumab withdrawal were serious adverse events (n = 7). Consequently, the treatment with tocilizumab has given the realistic opportunities for effective treatment of patients with JIA, including the perspective of a considerable reduction of risk of disability, withdrawal of glucocorticoid therapy and increasing the rate of remissions with complete cancellation of medications.