Session Information
Session Title: Pediatric Rheumatology - Clinical and Therapeutic Aspects I: Juvenile Idiopathic Arthritis
Session Type: Abstract Submissions (ACR)
Background/Purpose:
Lack of efficacy of Methotrexate, primary and secondary resistance to biologics and their intolerance lead to juvenile idiopathic arthritis (JIA) of progression. Therefore, the problem of switching to another biologic agent is very urgent.
The objective of this work was to evaluate the efficacy and safety of Etanercept plus Methotrexate in patients with JIA in case of infliximab primary/secondary inefficacy or intolerance.
Methods:
32 children were examined, 12 of them had oligoarthritis, 20 – polyarthritis. The average age of the children was 9.6 (3.0; 17.0) years. Duration of disease was 5,0 (3,0;8).
All patients received Infliximab as a first biologic agent. It was withdrawn in 8 cases due to primary inefficacy within first 3 months of therapy, in 21 – due to secondary inefficacy, and in 3 – to intolerance. The secondary Infliximab inefficacy developed at different periods of drug administration: within 3 m in 2 children, 6 m – 3 children, 9 m – 4 children, 14 m – 2 children, 18 m – 3 children, 24 m – 5 children, 36 m – 1 child, and 48 m 1 child. All patients were switched to Etanercept. Etanercept was given in the form of ubcutaneous injections twice a week at a dose 0.4 mg/kg on the background of Methotrexate at a dose 15 mg/m2/week. The observation period was 52 weeks. The efficacy of the therapy was assessed according to American College of Rheumatology (ACR-Pedi) criteria 50, 70, 90% improvement and remission criteria (Wallace, 2011).
Results:
The perfect effect of switching to the second inhibitor was obtained both in patients with the Infliximab secondary inefficacy and intolerance and in patients with the primary inefficacy of the first TNFα inhibitor. The pain was arrested in the patients within 1 m (the number of painful joints decreased from 6 (3;10.5); to 0; g <0,001); the number of joints with active arthritis significantly decreased (6 (3,5;12); 1 (0;3,5) before and after Week 4, respectively; g <0,001); and the number of joints with limited motion also decreased (6 (13,5;3,5); 2 (1;6,2) before and after Week 4, respectively; g <0,01). Remission of arthritis was observed within 3 m. Joints function recovered completely in 30 patients within 6 m of follow up. The permanent normalization of the serum CRP level and ESR was observed in all patients within 9 and 2 m, respectively. Within 1 month improvement according to ACR pedi criteria 50, 70, 90% was achieved in 84, 66, and 55% of patients, respectively. Within 3 months improvement 50/70 was achieved in 92 and 85% of patients, respectively. Inactive disease was registered in all patients within 6 months of follow up, the remission was observed in 85% of patients within 9 months and in 100% of patients within 12 months of observation. No withdrawals of the product due to primary, secondary inefficacy or intolerance were observed 1 year after switching. Adverse events were mild or moderate: acute bronchitis (1), local allergic reaction (2).
Conclusion:
Switching of patients with JIA with inadequate response to Infliximab to Etanercept ensured the development of remission and contributed to almost complete recovery of joint function in all patients. In addition to high therapeutic efficacy, Etanercept demonstrated good tolerability.
Disclosure:
E. Alekseeva,
Roche, Abbott, Pfizer, BMS, Centocor, Novartis,
2,
Roche, Merck, Abbott, BMS, Medac, Novartis, Pfizer,
8;
T. Bzarova,
None;
A. Fetisova,
None;
T. Sleptsova,
None;
S. Valieva,
None;
K. Isayeva,
None;
R. Denisova,
None;
E. Mitenko,
None;
E. Chistyakova,
None;
N. Taybulatov,
None.
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/the-efficacy-of-etanercept-in-patients-with-juvenile-idiopathic-arthritis-with-inadequate-response-to-infliximab-as-a-first-tnf-inhibitor/