title: Tumor necrosis factor-blocking agents for children with enthesitis-related arthritis--data from the dutch arthritis and biologicals in children register, 1999-2010.
abstract: OBJECTIVE
  To evaluate the effectiveness and safety of biological agents in children with enthesitis-related arthritis (ERA).
  
  
  METHODS
  All patients with ERA in whom a biological agent was initiated between 1999 and 2010 were selected from the Dutch Arthritis and Biologicals in Children (ABC) register. In this ongoing multicenter observational register, data on the course of the disease and medication use are retrieved prospectively at the start of the biological agent, after 3 months, and yearly thereafter. Inactive disease was assessed in accordance with the Wallace criteria.
  
  
  RESULTS
  Twenty-two patients with ERA started taking 1 or more biological agents: 20 took etanercept, 2 took adalimumab (1 switched from etanercept to adalimumab), and 2 took infliximab (1 switched from etanercept to infliximab). Characteristics: 77% were male, 77% had enthesitis, 68% were HLA-B27-positive. The median age of onset was 10.4 (IQR 9.4-12.0) years; median followup from the start of the biological agent was 1.2 (IQR 0.5-2.4) years. Intention-to-treat analysis shows that inactive disease was achieved in 7 of 22 patients (32%) after 3 months, 5 of 13 patients (38%) after 15 months, and 5 of 8 patients (63%) after 27 months of treatment. Two patients discontinued etanercept because of ineffectiveness, and switched to adalimumab (inactive disease achieved) or infliximab (decline in joints with arthritis after 3 months of treatment). One patient discontinued etanercept because of remission, but had flare and restarted treatment, with good clinical response. No serious adverse events occurred.
  
  
  CONCLUSIONS
  Tumor necrosis factor (TNF)-blocking agents seem effective and safe for patients with ERA that was previously unresponsive to 1 or more DMARD. However, a sustained disease-free state could not be achieved, and none discontinued TNF-blocking agents successfully.
authors.affiliation: Department of Pediatrics, Sp 1546, Erasmus MC Sophia Children's Hospital, PO Box 2060, 3000 CB Rotterdam, The Netherlands. m.otten@erasmusmc.nl
authors.forename: Marieke H
authors.initials: MH
authors.lastname: Otten
authors.forename: Femke H M
authors.initials: FH
authors.lastname: Prince
authors.forename: Marinka
authors.initials: M
authors.lastname: Twilt
authors.forename: Rebecca
authors.initials: R
authors.lastname: Ten Cate
authors.forename: Wineke
authors.initials: W
authors.lastname: Armbrust
authors.forename: Esther P A H
authors.initials: EP
authors.lastname: Hoppenreijs
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Koopman-Keemink
authors.forename: Nico M
authors.initials: NM
authors.lastname: Wulffraat
authors.forename: Simone L
authors.initials: SL
authors.lastname: Gorter
authors.forename: Koert M
authors.initials: KM
authors.lastname: Dolman
authors.forename: Joost F
authors.initials: JF
authors.lastname: Swart
authors.forename: J Merlijn
authors.initials: JM
authors.lastname: van den Berg
authors.forename: Marion A J
authors.initials: MA
authors.lastname: van Rossum
authors.forename: Lisette W A
authors.initials: LW
authors.lastname: van Suijlekom-Smit
mesh_terms: D000068879:Adalimumab; D000293:Adolescent; D017668:Age of Onset; D000911:Antibodies, Monoclonal / Q000009:adverse effects / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized / Q000009:adverse effects / Q000627:therapeutic use*; D018501:Antirheumatic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001171:Arthritis, Juvenile / Q000188:drug therapy*; D002648:Child; D002675:Child, Preschool; D000068800:Etanercept; D005260:Female; D006801:Humans; D007074:Immunoglobulin G / Q000009:adverse effects / Q000627:therapeutic use*; D007223:Infant; D000069285:Infliximab; D008297:Male; D009426:Netherlands; D011446:Prospective Studies; D018124:Receptors, Tumor Necrosis Factor / Q000627:therapeutic use*; D012042:Registries; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D018501:Antirheumatic Agents; D007074:Immunoglobulin G; D018124:Receptors, Tumor Necrosis Factor; D014409:Tumor Necrosis Factor-alpha; D000069285:Infliximab; D000068879:Adalimumab; D000068800:Etanercept