Background and Aims

In Kazakhstan, tocilizumab(TCZ) therapy was first authorized to treat systemic JIA(sJIA) patients in 2011 and, starting from 2014, it has been registered for poly-articular(pJIA) forms as well. TCZ was the only biologic registered in Kazakhstan for JIA therapy until 2015.

Methods

Data from children with JIA (n=81), who received TCZ in the 2011-2016 period, were retrospectively analyzed.

Results

TCZ was administered to 69 patients with sJIA and 12 patients with pJIA. Before TCZ, 53 patients received NSAIDs, DMARDs and glucocorticoids, whereas 28 patients immediately received it in monotherapy, due to the early onset of systemic manifestations.

In 96% of patients with sJIA, fever stopped after the first infusion and the skin manifestations completely resolved within 12 weeks in 85% of them; importantly, the articular involvement improved in all patients by 6 months. At this time point, TCZ was stopped in 23 patients and, eventually, only 3 of them relapsed and needed TCZ again.

As for pJIA, 11 patients reached the stage of inactive disease at 12 weeks of therapy. The ACRpedi 30/50/70/90 criteria at 6 months were fulfilled by 100%,75%,65% and 50% of these patients, respectively. The main factors of unfavorable prognosis resulted to be the disease duration before TCZ (>3 years) and the early onset of poly-articular involvement.

Seven patients had to stop TCZ for allergic reaction or leukopenia; 4 patients developed hepatitis, but needed only temporary suspension. One patient died, because of MAS.

Conclusions

TCZ has changed the JIA management in Kazakhstan/Central Asia and will improve its prognosis in these developing countries.