Combination Therapy of Abatacept and Anakinra in Children with Refractory Systemic Juvenile Idiopathic Arthritis: A Retrospective Case Series: Table 1.

To the Editor: Novel biological agents have provided improved treatment options for children with systemic juvenile idiopathic arthritis (sJIA). Anakinra, an interleukin 1 receptor antagonist, has been shown to effectively treat sJIA1,2,3,4,5; however, some patients may require multiple painful daily injections to control their disease. Another biologic, abatacept, selectively modulates the CD80/CD86:CD28 costimulatory signal necessary for T cell activation6 and has been shown to be effective in treating patients with sJIA who have a polyarticular course7. Rheumatologists are generally hesitant to combine biologics because of studies involving adults with rheumatoid arthritis showing no improvement when combining anti-cytokine biologics and an increased risk of infection8,9. However, Weinblatt, et al actually reported a lower incidence of severe adverse events in a small group of patients receiving anakinra and abatacept than in patients receiving anakinra and placebo, although the efficacy of this combination has not been formally evaluated8. Based on the available literature regarding the effectiveness of anakinra and abatacept in the treatment of sJIA independently, we have begun using these agents concurrently … Address correspondence to Dr. R.Q. Cron, Children’s Hospital of Alabama/University of Alabama at Birmingham, Children’s Park Place, Ste. 210, 1601 4th Avenue South, Birmingham, AL 35233, USA. E-mail: rcron{at}peds.uab.edu