Rituximab May Be Effective in Children With Treatment-Resistant Juvenile Idiopathic Arthritis

young girl holding her knee
young girl holding her knee
Rituximab may be an effective treatment option for many patients with juvenile idiopathic arthritis who did not respond to other therapies.

An analysis conducted in a real-world cohort of children with juvenile idiopathic arthritis (JIA), the majority of whom had polyarticular or extended oligoarticular disease, has demonstrated that rituximab may be an effective treatment option for patients who do not respond to tumor necrosis factor (TNF) inhibitor therapy, according to results published in Rheumatology.

The investigators sought to describe rituximab use and outcomes among children with JIA. The analysis included all patients with JIA within the UK Biologics for Children with Rheumatic Diseases study who were initiating rituximab therapy. Disease activity was evaluated at the start of treatment and at follow-up. The total number of courses of rituximab received by each patient was assessed. Infusion reactions and serious infections associated with the treatment were reported.

A total of 41 children who were initiating rituximab were enrolled in the study, of whom 14 had polyarthritis rheumatoid factor-negative disease, 13 had polyarthritis rheumatoid factor-positive disease, and 9 had extended oligoarthritis. Overall, 80% of the patients were girls, the median participant age was 15 years, and the median disease duration was 9 years.

At follow-up, improvements in disease activity were observed, with a significant median change in active joint count of −1 (interquartile range, −4 to 0; P <.05) and a median change in clinical Juvenile Arthritis Disease Activity Score of −9 units (interquartile range, −14 to 2 units). Of these patients, one-quarter (n=7) had received additional courses of rituximab, and 4 patients had been treated with another biologic agent before the follow-up evaluation.

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The median time between each course of rituximab was 219 days. During the follow-up period, 17 patients reported having switched to another biologic agent, including tocilizumab (n=8), abatacept (n=6), or a TNF inhibitor (n=3). There were 3 patients who reported a serious infection while receiving rituximab (rate of serious infections, 6.2 per 100 person-years). Moreover, 4 patients reported experiencing an infusion reaction.

The investigators concluded that rituximab can be used in children with JIA who have not responded to other treatments. The rate of occurrence of serious infections and the number of infusion reactions associated with use of rituximab are low. As patients continue to be followed within the ongoing Biologics for Children with Rheumatic Diseases study, real-world effectiveness of rituximab can continue to be evaluated.

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Kearsley-Fleet L, Sampath S, McCann LJ, et al. Use and effectiveness of rituximab in children and young people with juvenile idiopathic arthritis in a cohort study in the United Kingdom [published online October 24, 2018]. Rheumatology (Oxford). doi: 10.1093/rheumatology/key306