title: Long-term efficacy and safety of etanercept in children with polyarticular-course juvenile rheumatoid arthritis: interim results from an ongoing multicenter, open-label, extended-treatment trial.
abstract: OBJECTIVE
  To evaluate the long-term efficacy and safety of etanercept in children with juvenile rheumatoid arthritis (JRA) participating in an ongoing multicenter, open-label, extended-treatment trial. All patients had been participants in an initial randomized efficacy and safety trial of etanercept.
  
  
  METHODS
  Etanercept was administered at a dosage of 0.4 mg/kg (maximum 25 mg) subcutaneously twice each week. Safety and efficacy evaluations were performed every 3-4 months. The JRA 30% definition of improvement (DOI) was defined as improvement of > or =30% in at least 3 of 6 response variables used to assess disease activity, with no more than 1 variable worsening by more than 30%.
  
  
  RESULTS
  At the time of analysis, 48 of the 58 patients (83%) were still enrolled in the study; 43 of them (74%) had completed 2 years of treatment. Of these 43 patients, 81% met the JRA 30% DOI, 79% met the JRA 50% DOI, and 67% met the JRA 70% DOI. Ten children started low-dose methotrexate after year 1. Of the 32 children taking prednisone, the dosage was decreased to <5 mg/day in 26 (81%). Two children had serious infections (varicella with aseptic meningitis in one and complicated sepsis in the other). In general, adverse events were of the types seen in a general pediatric patient population.
  
  
  CONCLUSIONS
  Children with severe, longstanding, methotrexate-resistant polyarticular JRA demonstrated sustained clinical improvement with >2 years of continuous etanercept treatment. Etanercept was generally well-tolerated. There were no increases in the rates of adverse events over time. However, children taking etanercept should be monitored closely for infections.
authors.affiliation: Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio 45229-3039, USA. daniel.lovell@cchmc.org
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Lovell
authors.forename: Edward H
authors.initials: EH
authors.lastname: Giannini
authors.forename: Andreas
authors.initials: A
authors.lastname: Reiff
authors.forename: Olcay Y
authors.initials: OY
authors.lastname: Jones
authors.forename: Rayfel
authors.initials: R
authors.lastname: Schneider
authors.forename: Judyann C
authors.initials: JC
authors.lastname: Olson
authors.forename: Leonard D
authors.initials: LD
authors.lastname: Stein
authors.forename: Abraham
authors.initials: A
authors.lastname: Gedalia
authors.forename: Norman T
authors.initials: NT
authors.lastname: Ilowite
authors.forename: Carol A
authors.initials: CA
authors.lastname: Wallace
authors.forename: Mary
authors.initials: M
authors.lastname: Lange
authors.forename: Barbara K
authors.initials: BK
authors.lastname: Finck
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Burge
mesh_terms: D000293:Adolescent; D018501:Antirheumatic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D001171:Arthritis, Juvenile / Q000188:drug therapy*; D002648:Child; D002675:Child, Preschool; D018450:Disease Progression; D000068800:Etanercept; D005260:Female; D006801:Humans; D007074:Immunoglobulin G / Q000008:administration & dosage* / Q000009:adverse effects; D008297:Male; D018124:Receptors, Tumor Necrosis Factor / Q000008:administration & dosage*; D016896:Treatment Outcome
chemical_list: D018501:Antirheumatic Agents; D007074:Immunoglobulin G; D018124:Receptors, Tumor Necrosis Factor; D000068800:Etanercept