Recombinant Interleukin‐1 Receptor Antagonist Is an Effective First‐Line Treatment Strategy in New‐Onset Systemic Juvenile Idiopathic Arthritis, Irrespective of HLA‐DRB1 Background and IL1RN Variants

Erkens, RGA; Calis, JJA; Verwoerd, A; De Roock, S; Ter Haar, NM; Den Engelsman, G; Van der Veken, LT; Ernst, RF; Van Deutekom, HWM; Pickering, A; Scholman, RC; Jansen, MHA; Swart, JF; Sinha, R; Roth, J; Schulert, GS; Grom, AA; Van Loosdregt, J; Vastert, SJ

doi:10.1002/art.42656

Pediatric rheumatology

Recombinant Interleukin‐1 Receptor Antagonist Is an Effective First‐Line Treatment Strategy in New‐Onset Systemic Juvenile Idiopathic Arthritis, Irrespective of Human Leukocyte Antigen (HLA)‐DRB1 Background and IL1RN Variants

Arthritis RheumatolPublished 6 Nov 2023Prospective cohort study

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Authors' conclusion

We observed high rates of CID using anakinra as first-line treatment irrespective of HLA-DRB1 or IL1RN variants. Only one of the 17 HLA-DRB1*15:01 carriers developed sJIA-LD, and of the three patients with drug reactions to biologics, only one carried HLA-DRB1*15:01.

Study context

Population: Patients with new-onset systemic juvenile idiopathic arthritis (sJIA) treated with anakinra as first-line therapy
Participants: 65 patients

Exposure: Carriers vs noncarriers of HLA-DRB1 and IL1RN risk alleles
HLA-DRB1*15:01 carriersn = 17
Outcome: CID at 6 months, 1 year and 2 years

Methodological detailswhole-genome sequencing, anakinra as first-line therapy

Whole-genome sequencing
Anakinra as first-line therapy

Main finding

As reported in the abstract

Clinical inactive disease (CID) rates generally high, irrespective of HLA-DRB1 or IL1RN variants
CID rates significantly lower in carriers of an HLA-DRB1*11:01 allele

Observational data: associations, not effects.

Further findings

Eosinophilia at disease onset

P = 0.67

HLA-DRB1*15:01 carriers6.2%

Noncarriers14.9%

Eosinophilia after start of anakinra · first 2 years of disease

HLA-DRB1*15:01 carriers35.3%

Noncarriers37.5%

Outcome	HLA-DRB1*15:01 carriers	Noncarriers
HLA-DRB1*15:01 carriage	26%	— not stated in the abstract

— not stated in the abstract

HLA-DRB1*15:01 carriage

Comparable with the general population; enrichment for HLA-DRB1*11:01

Eosinophilia after start of anakinra · first 2 years of disease

Did not significantly differ

Safety

sJIA-LD — HLA-DRB1*15:01 carriers: 1 events

Severe drug reactions to biologics

3 patients, of whom 1 carried HLA-DRB1*15:01

Original publication

Recombinant Interleukin‐1 Receptor Antagonist Is an Effective First‐Line Treatment Strategy in New‐Onset Systemic Juvenile Idiopathic Arthritis, Irrespective of HLA‐DRB1 Background and IL1RN Variants. Arthritis Rheumatol. Published 6 November 2023. doi:10.1002/art.42656

Read the original article ↗

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