RT Journal Article
SR Electronic
T1 Neutropenia During Tocilizumab Treatment Is Not Associated With Infection Risk in Systemic or Polyarticular-Course Juvenile Idiopathic Arthritis
JF The Journal of Rheumatology
JO J Rheumatol
FD The Journal of Rheumatology
SP jrheum.180795
DO 10.3899/jrheum.180795
A1 Manuela Pardeo
A1 Jianmei Wang
A1 Nicolino Ruperto
A1 Ekaterina Alexeeva
A1 Vyacheslav Chasnyk
A1 Rayfel Schneider
A1 Gerd Horneff
A1 Hans-Iko Huppertz
A1 Kirsten Minden
A1 Karen Onel
A1 Lawrence Zemel
A1 Alan Martin
A1 Isabelle Koné-Paut
A1 Antigoni Siamopoulou-Mavridou
A1 Clovis A.  Silva
A1 Benjamin Porter-Brown
A1 Kamal N.  Bharucha
A1 Hermine I.  Brunner
A1 Fabrizio De Benedetti
YR 2019
UL http://www.jrheum.org/content/early/2019/02/25/jrheum.180795.abstract
AB Objective To determine whether neutropenia is associated with increased risk for infection in patients with systemic juvenile idiopathic arthritis (sJIA) and polyarticular-course juvenile idiopathic arthritis (pcJIA) treated with tocilizumab (TCZ). Methods Data up to week 104 from 2 phase 3 trials of intravenous TCZ in sJIA (n = 112; ClinicalTrials.gov, NCT00642460) and pcJIA (n = 188; ClinicalTrials.gov, NCT00988221) were pooled. Worst Common Toxicity Criteria grade and lowest observed absolute neutrophil count (ANC) were identified for each patient. Associations between patient characteristics and lowest observed ANC were tested using univariate regression analysis. Infection and serious infection rates (per 100 patient-years [PY]) in periods associated with grades 1/2 and 3/4 neutrophil counts were compared with rates associated with normal neutrophil counts. Results ANCs decreased to grade ≥3 in 25.0% and 5.9% of sJIA and pcJIA patients, respectively, and decreases were transient. Young age (p = 0.047) and methotrexate use (p = 0.012) were positively associated with neutropenia in patients with sJIA but not in patients with pcJIA. The rate of serious infections in patients with sJIA (10.9/100 PY; 95% CI, 6.8-16.5) tended to be higher than in patients with pcJIA (5.2/100 PY; 95% CI, 3-8.5). No increase in rates of serious or nonserious infections was observed during periods of neutropenia in either trial. Conclusion Patients with JIA treated with TCZ experienced transient neutropenia that was not associated with an increased number of infections.