Problems to Consider Before Determining the Regimen of the Treatment for Juvenile Systemic Sclerosis Treatment: A Case Report Where Tocilizumab Monotherapy Succeeded Efficiently and Safely

Use of biologic drug in the treatment of localized scleroderma and systemic sclerosis in children: A scoping review

OBJECTIVE

Biologic drugs are a potential treatment option in resistant cases of juvenile scleroderma. In this review, we aimed to examine previous studies regarding biologic drug use in pediatric patients with localized scleroderma and systemic sclerosis.

METHODS

We performed a search on MEDLINE and Scopus for articles involving pediatric localized scleroderma and systemic sclerosis patients treated with biologic drugs.

RESULTS

We identified 17 articles describing 58 pediatric patients with localized scleroderma treated with biologic drugs and 12 articles describing 29 pediatric patients with systemic sclerosis treated with biologic drugs during our literature search. The most frequently used biologic drug in localized scleroderma treatment was abatacept (55.2 %), followed by tocilizumab (48.3 %). These biologic drugs were mainly preferred for treating resistant/progressive skin disease in pediatric patients with localized scleroderma (58.5 % and 68.8 %, respectively). The improvement rates associated with abatacept and tocilizumab were 92.9 % and 77.4 %, respectively. Adverse events were observed in 23.5 % of all localized scleroderma patients. The most frequently used biologic drug in systemic sclerosis treatment was rituximab (51.7 %), followed by tocilizumab (44.8 %). Rituximab was predominantly favored for managing cardiac involvement (45.5 %), whereas tocilizumab was preferred for pulmonary involvement (50 %) in pediatric patients with systemic sclerosis. The improvement rates associated with rituximab and tocilizumab were 72.7 % and 94.1 %, respectively. Adverse events were reported in 40 % of all systemic sclerosis patients.

CONCLUSION

Our results showed that abatacept and tocilizumab were more frequently used in patients with localized scleroderma, while rituximab and tocilizumab were the predominantly used biologics in patients with systemic sclerosis. The improvement rate with these biologics were quite high with acceptable safety profile.

Best clinical practice in the treatment of juvenile systemic sclerosis: expert panel guidance - the result of the International Hamburg Consensus Meeting December 2022

INTRODUCTION

Juvenile systemic sclerosis (jSSc) is an orphan disease with a prevalence of 3 in 1,000,000 children. Currently there is only one consensus treatment guideline concerning skin, pulmonary and vascular involvement for jSSc, the jSSc SHARE (Single Hub and Access point for pediatric Rheumatology in Europe) initiative, which was based on data procured up to 2014. Therefore, an update of these guidelines, with a more recent literature and expert experience, and extension of the guidance to more aspects of the disease is needed.

AREAS COVERED

Treatment options were reviewed, and opinions were provided for most facets of jSSc including general management, some of which differs from adult systemic sclerosis, such as the use of corticosteroids, and specific organ involvement, such as skin, musculoskeletal, pulmonary, and gastroenterology.

EXPERT OPINION

We are suggesting the treat to target strategy to treat early to prevent cumulative disease damage in jSSc. Conclusions are derived from both expert opinion and available literature, which is mostly based on adult systemic sclerosis (aSSc), given shared pathophysiology, extrapolation of results from aSSc studies was judged reasonable.

Tocilizumab in systemic sclerosis treatment: a case report

Introduction

In the United States, tocilizumab was approved for the treatment of scleroderma and scleroderma-related interstitial lung disease because it inhibited the decrease in forced expiratory volume, so scleroderma treatment is entering a new era.

Case presentation

A 44-year-old female patient with systemic scleroderma, diagnosed 6 years ago, presented with breathlessness over the last week. The modified Rodnan's score was 18. Tocilizumab 162 mg subcutaneously once every 2 weeks was prescribed. After 4 weeks, a decrease in Rodnan score was observed. Tocilizumab was stopped after 6 months without any side effects due to treatment.

Discussion

Treatment with tocilizumab may maintain lung function nearly unchanged. Its effect on perfecting skin fibrosis seems promising. Tocilizumab may be fairly safe to use.

Conclusion

Tocilizumab may be effective and fairly safe to use. Further exploration is anticipated to advance a new period of systemic sclerosis treatment.