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Juvenile idiopathic arthritis (JIA) is the most common rheumatic disease in children. Children with JIA are at risk of inflammation of the uvea in the eye (uveitis).
In the initial stages of mild to moderate inflammation the uveitis is entirely asymptomatic. This has led to the current practice of screening all children with JIA regularly for uveitis.
Children with mild-moderate uveitis are treated with a combination of topical steroid drops and systemic Methotrexate. Methotrexate is an immunosuppressive drug that is used to treat inflammatory diseases including uveitis.
Previous research into combatting JIA-associated uveitis in children includes the SYCAMORE Trial, this was conducted by the APTITUDE team to assess the efficacy and safety of adamilumab, a monoclonal anti-Tumour Necrosis (anti-TNF) factor agent in the management of Methotrexate-refractory uveitis. The APTITUDE trial was complimentary to SYCAMORE as any potential patients who failed on anti-TNF therapy or who were not eligible for inclusion into SYCAMORE were eligible for the APTITUDE trial.
Tocilizumab (trade name RoActemra) is a biological therapy which blocks the action of interleukin (IL)-6. In arthritis, IL-6 causes tiredness, anaemia, and inflammation and damage to bones, cartilage and tissue. Tocilizumab reduces these effects.
The purpose of the study was to look at how effective the use of Tocilizumab in combination with Methotrexate was for the treatment of JIA- associated uveitis. The primary objective of this trial was to estimate the response rate to Tocilizumab in combination with MTX in children with JIA-associated uveitis who have already failed anti-TNF therapy.
- Ramanan AV, Dick AD, Guly C, Hardwick B, Hickey H, Jones AP, Lee R, McKay A, Beresford M. A phase II trial of Tocilizumab in anti-TNF refractory patients with JIA associated uveitis (APTITUDE TRIAL). BMC Rheumatology, 2018, Volume 2, Number 1, Page 1.