Objectives To study the influence of tocilizumab on lymphocyte subsets, immunoglobulin and biochemical indicators of Systemic juvenile idiopathic arthritis.
Methods DMARDs poor efficacy in children with severe SJIA 18 patients were divided into two groups, of which eight patients tocilizumab + DMARDs group (in cluding a case of refractory MAS), 10 patients in the placebo + DMARDs control group, according to the weight>30kg, 8mg/kg, <30kg, 12mg/kg, injected once every two weeks in hospital.Symptoms and CD3 +, CD4 +, CD8 + T, CD19 + B, CD16 + 56-NK cell ratio in two groups were observed by the flow cytometry before or after 12 weeks treatment. Comparing immunoglobulin IgG, IgM, IgA, IgE with baseline after the therepy in two group, and continuous observe inflammatory markers (CRP, ESR, FER, WBC) and ALT/AST changes, adverse reactions and reduce stopping hormone case inductive analysis in following 12 weeks.
Results After 12 weeks, tocilizumab + DMARDs group, CRP, ESR, FER were significantly decreased, the most frequently occurring adverse reaction was infection, mostly upper respiratory tract infection, followed by elevated transaminase, cholesterol, low-density lipoprotein High-density lipoprotein and triglyceride levels increased; two groups no serious adverse events (three-line reduction, severe infections, etc.). the proportion of CD4 + T, CD19 + B cells in Tocilizumab group were lower than baseline (P<0.05), CD8, CD3 + T cells were increased in comparing with baseline, however,no significant change with CD16 + 56-NK cells (P>0.05), and immunoglobulins IgG, IgM, IgA lower than baseline (P<0.05). The control group had no significant difference (P>0.05).
Conclusions Tocilizumab can significantly reduce inflammatory markers (CRP, ESR, FER), but affect lipid metabolism and ALT/AST.Blocking IL-6 can be adjusted hyperthyroidism humoral and regulate CD4 + T, CD19 + B cells, reduce joint destruction. Tocilizumab can effectively control the development of DMARDs poor efficacy SJIA.
Disclosure of Interest None declared