A combination of etanercept and methotrexate for the treatment of refractory juvenile idiopathic arthritis: a pilot study.
OBJECTIVE
To study the efficacy of combination therapy with etanercept and methotrexate in patients with refractory juvenile idiopathic arthritis.


METHODS
Seven children with active juvenile idiopathic arthritis refractory to at least combination therapy with methotrexate and sulfasalazine or cyclosporin A were studied. Concomitant treatment, consisting of non-steroidal drugs, corticosteroids, and methotrexate, remained unchanged.


RESULTS
Six patients continued the treatment for at least 24 weeks. In the child with systemic arthritis, etanercept was stopped because of persisting spiking fever, joint pain, and rash. In the remaining children an immediate significant decrease in joint pain (p<0.05), disappearance of morning stiffness, and regression of joint swelling (p<0.05) were observed. Improvement was apparent after two injections. An immediate significant (p<0.05) decrease in erythrocyte sedimentation rate, C reactive protein, and interleukin 6 was observed. Side effects consisted of mild reactions at the injection site in two children.


CONCLUSIONS
In this observational study, etanercept in combination with methotrexate was well tolerated and highly effective in treating juvenile polyarthritis but not in the patient with systemic arthritis. Combination treatment appears to be feasible in terms of toxicity and may enhance efficiency.
Schmeling
H
H
Department of Paediatrics, Martin-Luther University Halle-Wittenberg, 06120 Halle, Germany.
Mathony
K
K
John
V
V
Keysser
G
G
Burdach
S
S
Horneff
G
G
D000293:Adolescent; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001171:Arthritis, Juvenile / Q000097:blood / Q000188:drug therapy*; D001799:Blood Sedimentation; D002097:C-Reactive Protein / Q000032:analysis; D002648:Child; D004359:Drug Therapy, Combination; D004797:Enzyme-Linked Immunosorbent Assay; D000068800:Etanercept; D005260:Female; D006801:Humans; D007074:Immunoglobulin G / Q000627:therapeutic use*; D015850:Interleukin-6 / Q000097:blood; D008297:Male; D008727:Methotrexate / Q000627:therapeutic use*; D010865:Pilot Projects; D018124:Receptors, Tumor Necrosis Factor / Q000627:therapeutic use*; D012074:Remission Induction; D018709:Statistics, Nonparametric; D016896:Treatment Outcome
D018501:Antirheumatic Agents; D007074:Immunoglobulin G; D015850:Interleukin-6; D018124:Receptors, Tumor Necrosis Factor; D002097:C-Reactive Protein; D000068800:Etanercept; D008727:Methotrexate