TREATMENT OF REFRACTORY JUVENILE CHRONIC ARTHRITIS BY MONOCLONAL CD4 ANTIBODIES - A PILOT-STUDY IN 2 CHILDREN

Objective-To study the effect of anti-CD4 treatment in patients suffer ing from refractory systemic onset juvenile chronic arthritis (JCA). M ethods-Two children were treated with the mouse CD4 antibody MAX.16H5. The effects on numbers of circulating CD4 T cells, clinical symptoms and C reactive protein (CRP) level were studied and the appearance of human antimouse immunoglobulin antibodies investigated. Results-In pat ient one, disappearance of fever and malaise and a reduction of arthri tic activity were observed together with a reduction in CRP. When dise ase activity returned eight weeks later, a second successful course of treatment was administered. It was possible to reduce the corticoster oid dosage permanently. In the other child, a first treatment cycle di d not alter disease activity. A marked reduction in clinical and labor atory disease activity markers was observed after the second course. O nly transient and mild side effects were observed. One patient exhibit ed a short lasting febrile reaction with chills, the other an urticari al rash. In both patients, human antibodies to mouse immunoglobulin be came detectable. The decrease in the number of CD4 T cells in the peri pheral blood was only short lasting and numbers returned to normal val ues within one to eight weeks, even after the second course of antibod y treatment and under concomitant immunosuppressive treatment. No sust ained clinical remissions could be achieved. Conclusions-These prelimi nary observations support the evidence of positive effects of CD4 anti body treatment in refractory systemic onset JCA. Long term efficacy, h owever, remains to be established.