Open Access Highly Accessed Research article

Systematic review of disease-modifying antirheumatic drugs for juvenile idiopathic arthritis

Alex R Kemper*, Heather A Van Mater, Remy R Coeytaux, John W Williams and Gillian D Sanders

BMC Pediatrics 2012, 12:29  doi:10.1186/1471-2431-12-29

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Tocilizumab in JIA

Isidro Villanueva   (2012-05-31 14:16)  Genentech, a member of the Roche Group

April 27, 2012

To the Editor,

Upon reviewing the recently posted article ��Systematic review of disease-modifying antirheumatic drugs for juvenile idiopathic arthritis�� (BMC Pediatrics. 2012;12(1):29), we found inaccuracies in the characterization of tocilizumab. Table 1 states that tocilizumab has not been approved by the US Food and Drug Administration (FDA) for the treatment of JIA. On April 15, 2011, the FDA approved tocilizumab for patients aged 2 years and older with active systemic juvenile idiopathic arthritis (sJIA), which is a subtype of JIA.1

In the discussion of tocilizumab in the DMARD vs conventional therapy section, the paper states the following: ��From the RCT component, the active joint count in the tocilizumab group decreased from 3.5 to 0. Similarly, in the conventional group it decreased from 4 to 0.�� This is misleading as it appears to state that there is no difference between tocilizumab treatment and conventional treatment. Patients in the placebo arm (conventional group) of the double-blind phase were treated with open-label tocilizumab prior to withdrawal of drug and entrance into the double-blind phase of the trial. It was during this treatment with open-label tocilizumab that the median number of active joints decreased from 4 to 0. Following withdrawal of tocilizumab, the median number of active joints remained at 0.2 Although it is stated that this is a discontinuation trial, the quoted statements above make it appear as though the reduction of active joints occurred with conventional treatment.

Isidro Villanueva, MD, PhD
Senior Medical Director
US Medical Affairs, Immunology
Genentech, a member of the Roche Group

1. ACTEMRA�� (tocilizumab) [package insert]. South San Francisco, CA: Genentech, Inc.; 2011.

2. Yokota S, Imagawa T, Mori M, et al. Efficacy and safety of tocilizumab in patients with systemic-onset juvenile idiopathic arthritis: a randomised, double-blind, placebo-controlled, withdrawal phase III trial. Lancet. 2008;371(9617):998-1006.

Competing interests

Employment, Genentech, a member of the Roche Group


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