Choosing a Biologic Therapy for JIA: Etanercept vs Tocilizumab vs IL-1 Inhibitors

Illustration of systemic juvenile idiopathic arthritis
Illustration of systemic juvenile idiopathic arthritis
Treatment response was most significant in patients taking either tocilizumab or an interleukin-1 inhibitor.

Many patients with systemic-onset juvenile idiopathic arthritis (sJIA) who are treated with either tocilizumab or interleukin-1 (IL-1) inhibitors may experience remission or minimal disease activity defined by American College of Rheumatology (ACR) criteria, according to research published in Arthritis Research and Therapy.

Investigators identified patients with sJIA from the German Biologics register (BIKeR) who were exposed to treatment with either etanercept, tocilizumab, or IL-1 inhibitors. Efficacy was established using JIA-ACR response criteria and the Juvenile Disease Activity Score 10 (JADAS10). Safety was determined by adverse event reporting.

A total of 245 patients with sJIA who received 274 treatment approaches with biologic therapy since 2000 were identified: 143 were treated with etanercept, 71 with tocilizumab, and 60 with IL-1 inhibitors (38 with anakinra and 22 with canakinumab). Of the evaluated patients, 50.3% were male and the mean patient age ranged from 7.8±4.9 to 10.7±4.4 years.

At baseline, patients in the etanercept cohort reported fewer systemic disease manifestations but more active joints. The JIA-ACR 30/50/70/90 response (defined as 30%/50%/70%/90% or greater improvement in 3 or more of the 6 JIA core response variables) over 24 months was achieved more often in the IL-1 inhibitor and tocilizumab groups than in the etanercecpt group.

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Etanercept, tocilizumab, and IL-1 inhibitor JADAS remission (JADAS ≤1) was achieved in 20%, 37%, and 52% of patients, respectively; minimal disease activity (JADAS ≤3.8) in 35%, 61%, and 68% of patients, respectively; and ACR inactive disease in 24%, 33%, and 56% of patients, respectively. Rates of adverse events per patient-year were significantly higher in the tocilizumab group (risk ratio [RR], 5.3; P <.0001), and serious adverse events were reported significantly more often with tocilizumab therapy (RR, 2.5; P =.01) and IL-1 inhibitor use (RR, 2.9; P <.01) compared with etanercept treatment.

The investigators concluded that the number of patients with sJIA achieving disease remission is decidedly lower with etanercept compared with tocilizumab or IL-1 inhibitor therapy. The use of etanercept in the treatment of sJIA has decreased markedly in Germany.


Horneff G, Schulz AC, Klotsche J, et al. Experience with etanercept, tocilizumab and interleukin-1 inhibitors in systemic onset juvenile idiopathic arthritis patients from the BIKER registry. Arthritis Res Ther. 2017;19(1):256.