041. The National Centre For Paediatric Rheumatology (NCPR) Experience of the Use of Tocilizumab (Ro-Actemra) in the treatment of Juvenile Idiopathic Arthritis (JIA): A 7-Year Story

Abstract

Introduction: Tocilizumab is a recombinant-humanised-monoclonal-antibody that acts as an Interleukin-6-receptor-antagonist. Approved for the treatment of children over 2 years with Systemic-onset JIA (SoJIA) and Polyarticular JIA (pJIA), Tocilizumab has been used in the NCPR for these indications since 2010. Objective(s): Aim-To perform a retrospective review of all children with JIA attending the NCPR treated with Tocilizumab, and report on outcomes, tolerability and efficacy. Method(s): A retrospective review of all JIA patients receiving Tocilizumab was performed and baseline demographics recorded. Active disease was defined by active joint count (AJC), anD/Or presence of raised Acute Phase Reactants (APR). Pre-Tocilizumab biologic workup, infusion frequency and prior and adjunctive treatments were reviewed. Outcome measures included clinical remission (0 AJC) and time to remission. Result(s): Thirty-two children with JIA (81% Female, median age at diagnosis 5.1yr, 1.8-12.8yrs) have received Tocilizumab, 41% SoJIA, 34% pJIA (3/11 RF-positive), 25% Other. Median time to commencing Tocilizumab was 3.1yrs (0.9-10.4yrs). Prior to Tocilizumab, 97% of children received Methotrexate monotherapy. Following this, 91% received at least two Biologics, 6% received four. Pre-Tocilizumab 97% were Varicella immune, all TB negative. The average AJC was 17 (3-23joints) and APR were raised in 53%. All received Tocilizumab fortnightly at the outset. Escalation to weekly infusions was required in 28% (56% SoJIA). Adjuvant steroids were required in 56% at commencement of Tocilizumab. Complete steroid wean was achieved in 83%. Seventy-four percent of the cohort has achieved remission on Toci-lizumab. Average time to remission, 5mths (0.5-15mths). APR normalised in 76% after one infusion, 100% after three. Tocilizumab was discontinued in 22% (7/32). of the remaining twenty-five, 32% achieved reduced infusion frequency (3-8weekly). Conclusion(s): NCPR experience with Tocilizumab has been positive, with high rates of remission (74%) and tolerability, 78% remaining on the drug. Rather than using multiple biologics, this encourages consideration of the drug earlier.