Etanercept in Children with Polyarticular Juvenile Rheumatoid Arthritis

Abstract

Treatment with etanercept leads to significant improvement in patients with active polyarticular juvenile rheumatoid arthritis. Etanercept is well tolerated by pediatric patients.

A randomized, placebo‐controlled trial of infliximab plus methotrexate for the treatment of polyarticular‐course juvenile rheumatoid arthritis

“…These findings, despite the difference in the study design, are similar to those observed during the openlabel phase of a trial assessing the use of etanercept in JRA (8), and demonstrate the value of infliximab in maintaining efficacy for up to 1 year. Of note, 78 of the 122 children enrolled in the study (63.9%) subsequently entered a 3-year open-label extension.…”

“…The ACR Pedi 30 criteria have been validated, and their reliability in discriminating between active agent and placebo has been established in studies of NSAIDs (24,25), MTX (6), etanercept (8), and more recently, other biologic agents (26,27). We believe the lack of statistical significance between treatment groups in the present study resulted from the combination of a small sample size (60 patients per treatment group) and a higher-than-anticipated rate of response (49.2%) in the placebo group (28), which was likely due to a greater placebo effect associated with agents administered by infusion and a placebo treatment phase that was too brief.…”

“…Weekly methotrexate (MTX), at parenteral dosages of up to 15 mg/m 2 /week, has been established as an effective and safe therapy for polyarticular-course JRA (5)(6)(7). For children whose disease does not respond to MTX, anti-tumor necrosis factor (anti-TNF) therapy is a treatment option (8)(9)(10)(11). One such anti-TNF agent, infliximab, is a chimeric monoclonal antibody that specifically and potently binds and neutralizes soluble TNF␣ and its membrane-bound precursor.…”

Early outcomes and improvement of patients with juvenile idiopathic arthritis enrolled in a Canadian multicenter inception cohort

“…However, to put our results in perspective, in 2 recent clinical trials, 44% and 33% of patients with a severe polyarticular disease course who had failed treatment with methotrexate achieved an ACR Pedi 70 criteria response after 7 and 12 months, respectively, with etanercept, and in another trial, 52% reached this response after 1 year of infliximab treatment (21,22,28). The ACR Pedi 70 criteria response rate 6 months after starting methotrexate was 26% in a study of patients with polyarthritis, systemic arthritis, and extended oligoarthritis (17).…”

A randomized trial of parenteral methotrexate comparing an intermediate dose with a higher dose in children with juvenile idiopathic arthritis who failed to respond to standard doses of methotrexate

“…Subsequently, a higher dosage of MTX, up to 30 mg/m 2 / week, has been suggested as a therapeutic option for patients whose condition remains resistant to the standard dosage, but no randomized trial has ever confirmed this hypothesis (5). Although anti-tumor necrosis factor (anti-TNF) agents (6) have become available in recent years for the treatment of MTX-resistant patients, these medications are expensive and not available to all patients. Therefore, the definition of the optimal dosage of MTX in terms of efficacy and safety remains central to disease management.…”