ArticleFrontiers in immunology2025
Hypocomplementemia dynamics during tocilizumab therapy in systemic juvenile idiopathic arthritis: a retrospective longitudinal study.
Article in Frontiers in immunology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Objective: This study aimed to investigate the trajectory of complement C3 and C4 levels during tocilizumab (TCZ) treatment in patients with systemic juvenile idiopathic arthritis (sJIA), explore the dynamic relationship between hypocomplementemia and disease activity, and characterize adverse events during long-term TCZ therapy. Methods: A retrospective analysis was conducted on 19 sJIA patients diagnosed according to the 2019 PRINTO criteria. Clinical data, including C3 and C4 levels, disease activity (sJADAS10-ESR score), and adverse events, were collected at baseline and at intervals from 2 to 96 weeks following TCZ initiation. Statistical analyses were conducted accordingly. Results: The 19 analyzed patients (6 males, 31.58%; 13 females, 68.42%) had a median (IQR) age of disease onset of 6.75 (4.58-9.42) years and a median (IQR) follow-up duration of 2.08 (1.83-2.67) years. After 2 weeks of TCZ treatment, median (IQR) serum C3 levels declined from 1.45(1.27-1.75) g/L at baseline to 1.11 (0.97-1.18) g/L (a 23.45% reduction, Conclusions: Complement C3 and C4 levels during TCZ treatment follow a trajectory characterized by a rapid early decline followed by a sustained low-level plateau. Long-term hypocomplementemia appears to be well tolerated, with no increased risk of serious infections or autoimmune complications. These findings suggest that hypocomplementemia reflects deep IL-6 signaling inhibition rather than pathological complement consumption.
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