Вопросы современной педиатрии (May 2014)
EXPERIENCE IN APPLICATION OF TOCILIZUMAB AT SYSTEM VARIANT OF JUVENILE IDIOPATHIC ARTHRITIS IN THE REPUBLIC OF BASHKORTOSTAN
Abstract
Background: To summarize the experience in application of tocilizumab at system variant of juvenile idiopathic arthritis in the Republic of Bashkortostan. Patients and methods: In cardiorheumatologic department of Republican Pediatric Clinical Hospital of Ufa there were 9 children (6 boys and 3 girls) aged from 2,5 to 13,8 years (middle age — 8,2 years) under supervision. Middle age in a disease onset made 4,5 years. All patients were exposed to the combined antirheumatic therapy before prescription of tocilizumab. Despite the therapy, the patients still had a high degree of activity of a disease that was the basis for prescription of tocilizumab. The average single dose of a preparation made 11,2 mg/kg for children with body weight under 30 kg, 8,7 mg/kg for children over 30 kg. Results: 8 children were exposed to the continuous therapy with tocilizumab, therapy duration fluctuated from 6 to 52 (on the average 17,8) months. Treatment was stopped at 1 patient because of insufficient effect and at 1 patient because of the development of the undesirable phenomena. The minimum improvement defined as achievement of ACRpedi30 criterion was reached in all patients throughout the entire period of treatment by the preparation. The prescription of tocilizumab allowed to stop the system manifestations of a disease within 1 month of treatment in all children. The JADAS-27 index decreased twice (from 33,6 to 16,5) in 1 month from the beginning of the therapy. From the 3rd month of treatment all patients showed the normalization of indicators of the peripheral blood characterizing the activity of inflammatory process (ESR, contents of leukocytes and haemoglobin, SRP serumal level). In 3 and 6 months from the therapy beginning 7 patients reached 50%, and 5 and 6 — 70% improvement, respectively. Two children didn't reach 70% improvement in view of remaining insignificant or moderately active articulate syndrome. Conclusion: The analysis of the research results showed high efficiency of tocilizumab concerning system manifestations and activity of inflammatory process. At the same time 3 patients still suffered the moderate articular syndrome in the form of persistent oligoarthritis, 1 patient — in the form of polyarthritis.
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