Clinical characteristics of influenza virus infection in juvenile idiopathic arthritis patients treated with tocilizumab
Jun-ichi Kawada1, 2 , Yoshiro Kitagawa2 , Naomi Iwata2 , Yoshinori Ito1
24 May 2012
1 October 2012
16 October 2012
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Background Inhibition of interleukin-6 (IL-6) signaling
by tocilizumab is highly effective for treatment of refractory
juvenile idiopathic arthritis (JIA). It appears that IL-6
plays an important role in the immune response to the
influenza virus, but it is not clear whether treatment with
tocilizumab affects the severity of influenza.
Methods We retrospectively collected clinical and laboratory
data from JIA patients (n = 33) treated with tocilizumab.
Ten patients who developed influenza
(tocilizumab group; 10.1 %, 10/99 patient-years) were
analyzed. Eleven JIA patients who experienced influenza
during conventional treatments, without tocilizumab (control
group), were compared with the tocilizumab group.
Results Of the 10 patients in the tocilizumab group, 6
patients did not have high fever ([38 C), and the other 4
febrile patients recovered from fever in 1 day. White blood
cell counts and lymphocyte counts were significantly lower
at the acute phase of infection compared with data from
before influenza infection. The degree of fever and level of
C-reactive protein in the tocilizumab group were significantly
reduced compared with the control group.
Conclusions IL-6 inhibition by tocilizumab reduced
inflammation associated with infection and resulted in mild
symptoms during influenza. Leukopenia might be a useful
indicator of viral infection, including influenza, during
tocilizumab treatment.
Juvenile idiopathic arthritis, Influenza, Tocilizumab