Efficacy and safety of TNF-alpha antagonists in children with juvenile idiopathic arthritis who started treatment under 4 years of age

Abstract

The aims of the study were to assess efficacy and safety of TNF-alpha antagonists (anti-TNF) in a cohort of patients with juvenile idiopathic arthritis (JIA) who began treatment under 4 years old and to assess relapse rate after methotrexate and/or anti-TNF withdrawal. We made a retrospective charts review of our non-systemic JIA patients treated with anti-TNF under 4 years of age between January 2006 and April 2013. Demographics, epidemiologic, clinical, laboratory data and rate of relapse after treatment withdrawal due to clinical remission were collected. Efficacy and safety end points included side effects (SE) and time to achieve clinical remission. We included 27 patients, 23 received etanercept and 4 adalimumab with a median age of 3.01 (range 0.88-3.97) years at anti-TNF beginning and 1.94 (range 0.18-5.44) and 2.39 (range 0.18-7.24) years of treatment and follow-up, respectively. All patients had previously received disease-modifying antirheumatic drugs at optimal dose. Nineteen patients reached clinical remission on treatment in a median time of 9.1 (range 6.23-21.17) months. Four of those relapsed during treatment. Six developed mild SE, mostly mild infections. No serious SE were described. Eleven patients who reached clinical remission relapsed after treatment withdrawal. None achieved clinical remission off treatment. Most patients reached clinical remission on anti-TNF. In our cohort of patients, etanercept and adalimumab were safe, with mostly mild infections and no serious SE. We observed a high relapse rate during treatment withdrawal.

Biologics and Pediatric Generalized Pustular Psoriasis: An Emerging Therapeutic Trend

“…Previous literature examining the use of etanercept in other conditions (Crohn’s disease, juvenile idiopathic arthritis (JIA), and uveitis) supports its use in pediatric patients suffering from psoriasis [ 30 ]. In 23 patients suffering from JIA, etanercept use was deemed safe to use, with patients only experiencing side effects of mild infections and no serious side effects noted [ 33 ]. Multiple publications involving JIA report no incidence of demyelination, malignancies, or death [ 34 - 35 ].…”

“…JIA studies examining adalimumab use have also deemed it safe and effective for up to 60 weeks [ 33 , 44 - 45 ]. When compared to methotrexate, Klotsche, et al described an increased risk of significant adverse effects with adalimumab, but no increase in malignancies, stating that adalimumab has an acceptable long-term tolerability [ 36 ].…”

Etanercept or adalimumab: which is a better biological therapy for juvenile idiopathic arthritis?

“…Observational studies, both prospective6–9 and retrospective,10 did not show a difference in efficacy. One study did find patients on EDA had higher tumour necrosis factor-a levels, despite improved clinical outcomes,8 although the significance of this contradictory finding is not explained.…”

High Levels of DEK Autoantibodies in Sera of Patients With Polyarticular Juvenile Idiopathic Arthritis and With Early Disease Flares Following Cessation of Anti–Tumor Necrosis Factor Therapy

“…DEK autoantibody levels in patients receiving anti‐TNF therapy. Anti‐TNF therapy has proven to be a very valuable modality in the treatment of JIA . However, it is expensive, and its immunosuppressive effects can lead to opportunistic infections, skin disorders, colitis, and malignancies .…”

“…The treatment of JIA has recently been improved by biologic response modifiers such as anti–tumor necrosis factor (anti‐TNF) therapy . However, anti‐TNF therapy is associated with significant adverse events, including infections and a possible increased risk of cancer .…”