Shumpei Yokota1, Yasuhiko Itoh2, Tomohiro Morio2, Naokata Sumitomo2, Kaori Daimaru2, Seiji Minota2. 1. From The Safety Evaluation Committee of Tocilizumab for JIA; Department of Pediatrics, Nippon Medical School; Department of Pediatrics and Developmental Biology, Tokyo Medical and Dental University (TMDU) Graduate School of Medical and Dental Sciences; Chugai Pharmaceutical Co. Ltd., Tokyo; Department of Pediatrics, Yokohama City University School of Medicine, Kanagawa; Department of Pediatric Cardiology, Saitama Medical University International Medical Center, Saitama; Division of Rheumatology and Clinical Immunology, Jichi Medical School, Tochigi, Japan.S. Yokota, MD, PhD, the Safety Evaluation Committee of Tocilizumab for JIA, and the Department of Pediatrics, Yokohama City University School of Medicine; Y. Itoh, MD, the Safety Evaluation Committee of Tocilizumab for JIA, and the Department of Pediatrics, Nippon Medical School; T. Morio, MD, the Safety Evaluation Committee of Tocilizumab for JIA, and the Department of Pediatrics and Developmental Biology, TMDU Graduate School of Medical and Dental Sciences; N. Sumitomo, MD, the Safety Evaluation Committee of Tocilizumab for JIA, and the Department of Pediatric Cardiology, Saitama Medical University International Medical Center; K. Daimaru, BS, Chugai Pharmaceutical Co. Ltd.; S. Minota, MD, the Safety Evaluation Committee of Tocilizumab for JIA, and the Division of Rheumatology and Clinical Immunology, Jichi Medical School. syokota@med.yokohama-cu.ac.jp. 2. From The Safety Evaluation Committee of Tocilizumab for JIA; Department of Pediatrics, Nippon Medical School; Department of Pediatrics and Developmental Biology, Tokyo Medical and Dental University (TMDU) Graduate School of Medical and Dental Sciences; Chugai Pharmaceutical Co. Ltd., Tokyo; Department of Pediatrics, Yokohama City University School of Medicine, Kanagawa; Department of Pediatric Cardiology, Saitama Medical University International Medical Center, Saitama; Division of Rheumatology and Clinical Immunology, Jichi Medical School, Tochigi, Japan.S. Yokota, MD, PhD, the Safety Evaluation Committee of Tocilizumab for JIA, and the Department of Pediatrics, Yokohama City University School of Medicine; Y. Itoh, MD, the Safety Evaluation Committee of Tocilizumab for JIA, and the Department of Pediatrics, Nippon Medical School; T. Morio, MD, the Safety Evaluation Committee of Tocilizumab for JIA, and the Department of Pediatrics and Developmental Biology, TMDU Graduate School of Medical and Dental Sciences; N. Sumitomo, MD, the Safety Evaluation Committee of Tocilizumab for JIA, and the Department of Pediatric Cardiology, Saitama Medical University International Medical Center; K. Daimaru, BS, Chugai Pharmaceutical Co. Ltd.; S. Minota, MD, the Safety Evaluation Committee of Tocilizumab for JIA, and the Division of Rheumatology and Clinical Immunology, Jichi Medical School.
Abstract
OBJECTIVE: To identify macrophage activation syndrome (MAS) in patients with systemic juvenile idiopathic arthritis (sJIA) undergoing tocilizumab (TCZ) treatment, and to confirm laboratory marker changes and responses to treatment in patients with MAS receiving TCZ. METHODS: In Japan, 394 patients with sJIA were registered in an all-patient registry surveillance of TCZ as of January 15, 2012. TCZ (8 mg/kg) was administered every 2 weeks to patients with sJIA. MAS, hemophagocytic lymphohistiocytosis, or Epstein-Barr virus-associated hemophagocytic syndrome (EB-VAHS) was reported in 23 of these patients (25 events). The Safety Evaluation Committee of Tocilizumab for JIA reviewed these cases and clinically evaluated the data and laboratory findings using their own therapeutic experience. Events were categorized into 4 groups: definitive MAS, probable MAS, EB-VAHS, and non-MAS. RESULTS: The committee's review revealed 3 events of definitive MAS in 3 patients, 12 events of probable MAS in 11 patients, 2 events of EB-VAHS in 2 patients, and 8 events of non-MAS in 8 patients. There were 2 patients who developed 2 events: 2 events in 1 patient were classified into definitive MAS and probable MAS, and 2 events in another patient were classified into probable MAS. In patients with definitive or probable MAS, common clinical manifestations and laboratory findings of MAS were observed. Changes in laboratory data observed in patients with EB-VAHS were similar to those observed in patients with MAS. CONCLUSION: These results suggest that the clinical/laboratory features in the course of MAS appear to be similar among patients regardless of whether TCZ is administered. Similarities in the pathophysiological background of MAS and EB-VAHS were also suggested.
OBJECTIVE: To identify macrophage activation syndrome (MAS) in patients with systemic juvenile idiopathic arthritis (sJIA) undergoing tocilizumab (TCZ) treatment, and to confirm laboratory marker changes and responses to treatment in patients with MAS receiving TCZ. METHODS: In Japan, 394 patients with sJIA were registered in an all-patient registry surveillance of TCZ as of January 15, 2012. TCZ (8 mg/kg) was administered every 2 weeks to patients with sJIA. MAS, hemophagocytic lymphohistiocytosis, or Epstein-Barr virus-associated hemophagocytic syndrome (EB-VAHS) was reported in 23 of these patients (25 events). The Safety Evaluation Committee of Tocilizumab for JIA reviewed these cases and clinically evaluated the data and laboratory findings using their own therapeutic experience. Events were categorized into 4 groups: definitive MAS, probable MAS, EB-VAHS, and non-MAS. RESULTS: The committee's review revealed 3 events of definitive MAS in 3 patients, 12 events of probable MAS in 11 patients, 2 events of EB-VAHS in 2 patients, and 8 events of non-MAS in 8 patients. There were 2 patients who developed 2 events: 2 events in 1 patient were classified into definitive MAS and probable MAS, and 2 events in another patient were classified into probable MAS. In patients with definitive or probable MAS, common clinical manifestations and laboratory findings of MAS were observed. Changes in laboratory data observed in patients with EB-VAHS were similar to those observed in patients with MAS. CONCLUSION: These results suggest that the clinical/laboratory features in the course of MAS appear to be similar among patients regardless of whether TCZ is administered. Similarities in the pathophysiological background of MAS and EB-VAHS were also suggested.
Authors: Mark Wunderlich; Courtney Stockman; Mahima Devarajan; Navin Ravishankar; Christina Sexton; Ashish R Kumar; Benjamin Mizukawa; James C Mulloy Journal: JCI Insight Date: 2016-09-22
Authors: Grant S Schulert; Shima Yasin; Brenna Carey; Claudia Chalk; Thuy Do; Andrew H Schapiro; Ammar Husami; Allen Watts; Hermine I Brunner; Jennifer Huggins; Elizabeth D Mellins; Esi M Morgan; Tracy Ting; Bruce C Trapnell; Kathryn A Wikenheiser-Brokamp; Christopher Towe; Alexei A Grom Journal: Arthritis Rheumatol Date: 2019-10-01 Impact factor: 10.995