Etanercept (Enbrel) in the treatment of juvenile idiopathic arthritis.
BACKGROUND
Juvenile idiopathic arthritis (JIA) is a relatively common multidimensional and heterogeneous chronic disease of childhood. Children with JIA are at risk for significant morbidity in terms of joint damage, impairments in physical function and health-related quality of life. Outcomes for children with JIA have significantly improved with the use of biologic therapies in the past 15 years, with the most clinical experience being with etanercept .


METHODS
Basic pharmacokinetic and pharmacodynamic data for etanercept will be highlighted. This article will review the clinical trials and open-label registry data for the efficacy and safety of etanercept for use in JIA.


CONCLUSIONS
Etanercept is very effective for the treatment of JIA. Data from clinical trials and open-label studies support its clinical efficacy in 80% of patients which appears to be sustained over several years for the majority of treated patients. The safety profile is also acceptable with a serious adverse event rate of 0.03 - 0.12 per patient-year. Further research is needed to evaluate any possible link between biologic therapy, JIA and malignancy, to obtain more long-term safety data, and to document improvements in quality of care and cost-benefit for associated with biologic therapies which may additionally assist in access to these medications. Further, identification of potential clinical or laboratory markers allowing for prediction of response and timing of starting and cessation of this biologic therapy are urgently required.
Pediatric Rheumatologist, Western University, Children's Hospital, London Health Sciences Centre, 800 Commissioners Road East, London, Ontario N6A5W9 , Canada +519 685 8138 ; +519 685 8156 ; roberta.berard@lhsc.on.ca.
Roberta A
RA
Berard
Ronald M
RM
Laxer
D000293:Adolescent; D001171:Arthritis, Juvenile / Q000188:drug therapy*; D001688:Biological Products / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D018572:Disease-Free Survival; D004311:Double-Blind Method; D000068800:Etanercept; D006801:Humans; D007074:Immunoglobulin G / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D007223:Infant; D055118:Medication Adherence; D015337:Multicenter Studies as Topic / Q000706:statistics & numerical data; D009369:Neoplasms / Q000139:chemically induced; D057240:Patient Preference; D011358:Product Surveillance, Postmarketing; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic / Q000706:statistics & numerical data; D018124:Receptors, Tumor Necrosis Factor / Q000627:therapeutic use*; D012042:Registries; D012074:Remission Induction; D018401:Sample Size; D015983:Selection Bias; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors
D001688:Biological Products; D007074:Immunoglobulin G; D018124:Receptors, Tumor Necrosis Factor; D014409:Tumor Necrosis Factor-alpha; D000068800:Etanercept