tacrolimus and Arthritis--Juvenile

In this review we summarize selected articles that have been published about immunosuppressive agents in the past year. These studies fall into three major categories: 1) use of pulse cyclophosphamide in autoimmune diseases other than systemic lupus erythematosus; 2) use of newer immunosuppressive agents such as cyclosporine and FK506 in a variety of rheumatic diseases; and 3) toxicity.

Topics: Adult; Arthritis, Juvenile; Azathioprine; Behcet Syndrome; Child; Cladribine; Cyclophosphamide; Cyclosporine; Drug Therapy, Combination; Granulomatosis with Polyangiitis; Humans; Hydroxychloroquine; Immunosuppressive Agents; Liver; Lung; Lung Injury; Lupus Erythematosus, Systemic; Methotrexate; Pemphigoid, Benign Mucous Membrane; Retina; Tacrolimus; Thalidomide

To evaluate the efficacy and safety of tacrolimus in patients with juvenile idiopathic arthritis (JIA).. We retrospectively analysed 27 patients with JIA who received tacrolimus therapy at the Department of Pediatric Rheumatology of the Tokyo Medical and Dental University between April 2019 and August 2020. We collected background and clinical characteristics at the time of add-on tacrolimus therapy initiation (baseline; Month 0) and after 3, 6, and 12 months. The primary outcome was successful medication reduction after 12 months. Patients requiring reduced and additional treatments were assigned as 'did not require additional treatment patients' and 'required additional treatment patients', respectively. The Wilcoxon signed-rank test was used to evaluate the continuous distribution of laboratory data and Juvenile Arthritis Disease Activity Score-27 at 3, 6, and 12 months relative to baseline values. Statistical significance was set as p < .05.. Among the 27 included cases, 17 patients were classified as did not require additional treatment patients, and there was a significant improvement in Juvenile Arthritis Disease Activity Score-27 scores in this group (p < .05). No patients presented tacrolimus-related adverse events throughout the study period.. Tacrolimus is an effective and safe therapeutic alternative for approximately 60% of patients with JIA.

Topics: Antirheumatic Agents; Arthritis, Juvenile; Child; Humans; Retrospective Studies; Tacrolimus; Treatment Outcome

Topics: Antibodies, Monoclonal, Humanized; Arthritis, Juvenile; Bursitis; Child, Preschool; Drug Substitution; Hip Joint; Humans; Immunosuppressive Agents; Magnetic Resonance Imaging; Male; Matrix Metalloproteinase 3; Psoas Muscles; Tacrolimus

Biologic agents are a beneficial therapy for juvenile idiopathic arthritis (JIA). However, there is a lack of evidence with regard to management of these agents for JIA patients who undergo kidney transplantation (KTx). A 36-year-old woman with JIA who was treated with tocilizumab targeting interleukin-6 (IL-6) receptor underwent ABO-incompatible kidney transplantation (ABOi KTx). To prevent over-immunosuppression, tocilizumab was discontinued before ABOi KTx. Rituximab, tacrolimus, mycophenolate mofetil, everolimus, and methylprednisolone were used for immunosuppression. Clinical remission of joint pain was maintained for over 3 years despite complete discontinuation of tocilizumab. Both serum IL-6 and soluble IL-6 receptor levels were markedly decreased, suggesting that multitargeted immunosuppression for ABOi KTx induced long-term clinical remission of JIA through inhibition of the IL-6 pathway. However, levels of C-reactive protein (CRP) and matrix metalloproteinase-3 (MMP-3) gradually increased thereafter and abatacept was initiated to prevent joint deterioration. These levels decreased without any adverse events. The patient's renal graft function was well maintained.

Topics: Abatacept; ABO Blood-Group System; Adult; Antibodies, Monoclonal, Humanized; Arthritis, Juvenile; Blood Group Incompatibility; Everolimus; Female; Humans; Immunosuppression Therapy; Immunosuppressive Agents; Kidney Transplantation; Postoperative Complications; Rituximab; Tacrolimus; Transplants

Topics: Arthritis, Juvenile; Child; Female; Follow-Up Studies; Humans; Immunosuppressive Agents; Tacrolimus

Topics: Arthritis, Juvenile; Child, Preschool; Epstein-Barr Virus Infections; Female; Gastroenteritis; Humans; Immunosuppressive Agents; Prednisolone; Stomach Ulcer; Tacrolimus

Topics: Administration, Oral; Administration, Topical; Adolescent; Arthritis, Juvenile; Humans; Immunosuppressive Agents; Male; Methotrexate; Prednisolone; Pyoderma Gangrenosum; Tacrolimus; Treatment Outcome; Ulcer