Efficacy of etanercept for the treatment of juvenile idiopathic arthritis according to the onset type.
OBJECTIVE
To assess the efficacy of etanercept in patients with juvenile idiopathic arthritis (JIA), and to assess the tolerance of these patients to etanercept.


METHODS
All JIA patients with active chronic polyarthritis, who were first treated with etanercept between November 1999 and June 2001 in 18 French centers because of poor response or intolerance to methotrexate, were included in this open-label, prospective, multicenter study. A standardized questionnaire was sent to the treating physicians. We assessed the validated international core-set score for JIA activity every 3 months and performed an intent-to-treat analysis. We also compared the risk of treatment failure in patients defined as having systemic-onset, oligoarticular-onset, or polyarticular-onset JIA.


RESULTS
Sixty-one patients were enrolled and were followed up for a median of 13 months. Treatment had to be stopped in 1 patient who became pregnant and in 12 patients due to severe side effects, including neurologic or psychiatric disorders, retrobulbar optic neuropathy, major weight gain, severe infection, cutaneous vasculitis with systemic symptoms, hemorrhagic diarrhea, uveitis flare, and pancytopenia. All of these side effects disappeared after discontinuation of etanercept. Crohn's disease was subsequently diagnosed in 1 child. Scores improved by > or =30% in 73% of patients after 3 months, but this proportion decreased to 39% after 12 months. The response rate was significantly lower in patients with systemic-onset JIA than in those with oligoarticular- or polyarticular-onset JIA.


CONCLUSIONS
Treatment of JIA with etanercept may be associated with a wide spectrum of severe side effects. Although most patients initially respond to etanercept, this initial response is not always followed by sustained improvement over longer periods of time. In addition, the higher rate of treatment failure in the group with systemic-onset JIA indicates that these patients in particular may require alternative treatments.
Quartier
Pierre
P
Hôpital Necker-Enfants Malades, Paris, France. quartier@necker.fr
Taupin
Pierre
P
Bourdeaut
Franck
F
Lemelle
Irène
I
Pillet
Pascal
P
Bost
Michel
M
Sibilia
Jean
J
Koné-Paut
Isabelle
I
Gandon-Laloum
Sylvie
S
LeBideau
Marc
M
Bader-Meunier
Brigitte
B
Mouy
Richard
R
Debré
Marianne
M
Landais
Paul
P
Prieur
Anne-Marie
AM
D000293:Adolescent; D000328:Adult; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D018771:Arthralgia; D001171:Arthritis, Juvenile / Q000145:classification / Q000188:drug therapy* / Q000503:physiopathology; D002648:Child; D002675:Child, Preschool; D000068800:Etanercept; D005260:Female; D006304:Health Status; D006801:Humans; D007074:Immunoglobulin G / Q000627:therapeutic use*; D007596:Joints / Q000503:physiopathology; D008297:Male; D018124:Receptors, Tumor Necrosis Factor / Q000627:therapeutic use*; D011993:Recombinant Fusion Proteins / Q000627:therapeutic use*; D012720:Severity of Illness Index; D016896:Treatment Outcome
D018501:Antirheumatic Agents; D007074:Immunoglobulin G; D018124:Receptors, Tumor Necrosis Factor; D011993:Recombinant Fusion Proteins; D000068800:Etanercept