title: Efficacy and safety of TNF-alpha antagonists in children with juvenile idiopathic arthritis who started treatment under 4 years of age.
abstract: The aims of the study were to assess efficacy and safety of TNF-alpha antagonists (anti-TNF) in a cohort of patients with juvenile idiopathic arthritis (JIA) who began treatment under 4 years old and to assess relapse rate after methotrexate and/or anti-TNF withdrawal. We made a retrospective charts review of our non-systemic JIA patients treated with anti-TNF under 4 years of age between January 2006 and April 2013. Demographics, epidemiologic, clinical, laboratory data and rate of relapse after treatment withdrawal due to clinical remission were collected. Efficacy and safety end points included side effects (SE) and time to achieve clinical remission. We included 27 patients, 23 received etanercept and 4 adalimumab with a median age of 3.01 (range 0.88-3.97) years at anti-TNF beginning and 1.94 (range 0.18-5.44) and 2.39 (range 0.18-7.24) years of treatment and follow-up, respectively. All patients had previously received disease-modifying antirheumatic drugs at optimal dose. Nineteen patients reached clinical remission on treatment in a median time of 9.1 (range 6.23-21.17) months. Four of those relapsed during treatment. Six developed mild SE, mostly mild infections. No serious SE were described. Eleven patients who reached clinical remission relapsed after treatment withdrawal. None achieved clinical remission off treatment. Most patients reached clinical remission on anti-TNF. In our cohort of patients, etanercept and adalimumab were safe, with mostly mild infections and no serious SE. We observed a high relapse rate during treatment withdrawal.
authors.affiliation: Unit of Pediatric Rheumatology, Department of Pediatrics, Hospital Sant Joan de Déu, Passeig Sant Joan de Déu 2, 08950, Esplugues de Llobregat, Barcelona, Spain, cgimenez@hsjdbcn.org.
authors.forename: Clara
authors.initials: C
authors.lastname: Giménez-Roca
authors.forename: Estíbaliz
authors.initials: E
authors.lastname: Iglesias
authors.forename: Vicenç
authors.initials: V
authors.lastname: Torrente-Segarra
authors.forename: Rosa
authors.initials: R
authors.lastname: Bou
authors.forename: Judith
authors.initials: J
authors.lastname: Sánchez-Manubens
authors.forename: Joan
authors.initials: J
authors.lastname: Calzada-Hernández
authors.forename: Samuel
authors.initials: S
authors.lastname: Hernández
authors.forename: Sílvia
authors.initials: S
authors.lastname: Ricart
authors.forename: Jordi
authors.initials: J
authors.lastname: Antón
mesh_terms: D000068879:Adalimumab; D000367:Age Factors; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use*; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001171:Arthritis, Juvenile / Q000188:drug therapy*; D002675:Child, Preschool; D004359:Drug Therapy, Combination; D000068800:Etanercept; D005260:Female; D006801:Humans; D007074:Immunoglobulin G / Q000627:therapeutic use*; D007223:Infant; D008297:Male; D008727:Methotrexate / Q000627:therapeutic use; D018124:Receptors, Tumor Necrosis Factor / Q000627:therapeutic use*; D012008:Recurrence; D012074:Remission Induction; D012189:Retrospective Studies; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*; D028761:Withholding Treatment
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D018501:Antirheumatic Agents; D007074:Immunoglobulin G; D018124:Receptors, Tumor Necrosis Factor; D014409:Tumor Necrosis Factor-alpha; D000068879:Adalimumab; D000068800:Etanercept; D008727:Methotrexate
references.citation: J Rheumatol. 2001 Sep;28(9):2116-9
references.pmid: 11550984
references.citation: Clin Rheumatol. 2009 Aug;28(8):985-8
references.pmid: 19322622
references.citation: Clin Exp Rheumatol. 1996 Jul-Aug;14(4):441-4
references.pmid: 8871846
references.citation: Clin Rheumatol. 2014;33(10):1433-41
references.pmid: 24487484
references.citation: Ann Rheum Dis. 2011 Oct;70(10):1704-12
references.pmid: 21813547
references.citation: J Clin Psychol Med Settings. 2011 Sep;18(3):291-8
references.pmid: 21630002
references.citation: Arthritis Rheum. 2007 Feb 15;57(1):35-43
references.pmid: 17266064
references.citation: Arthritis Care Res (Hoboken). 2010 Jul;62(7):1034-9
references.pmid: 20235203
references.citation: Clin Exp Rheumatol. 1987 Jul-Sep;5(3):217-23
references.pmid: 3501354
references.citation: Clin Exp Rheumatol. 1998 Jan-Feb;16(1):99-101
references.pmid: 9543575
references.citation: J Rheumatol. 2004 Feb;31(2):390-2
references.pmid: 14760812
references.citation: Arthritis Care Res (Hoboken). 2011 Jul;63(7):929-36
references.pmid: 21717596
references.citation: J Rheumatol. 2012 Jun;39(6):1287-90
references.pmid: 22589254
references.citation: Arthritis Rheum. 2006 Apr 15;55(2):199-207
references.pmid: 16583399
references.citation: Rheumatol Int. 2008 Aug;28(10):1031-4
references.pmid: 18369626
references.citation: Scand J Rheumatol. 2010 Nov;39(6):472-9
references.pmid: 20858139
references.citation: Nat Rev Rheumatol. 2013 Sep;9(9):532-43
references.pmid: 23820860
references.citation: Nat Rev Rheumatol. 2011 Jun 07;7(7):416-26
references.pmid: 21647204
references.citation: Rheumatol Int. 2014 Aug;34(8):1053-7
references.pmid: 24162563
references.citation: Rheumatol Int. 2009 Jan;29(3):275-9
references.pmid: 18690442