Pediatric Rheumatology Online Journal → June 2003 → Medical Treatment → Anti-tumor necrosis factor therapy→ Abstract #52
                                                                August 2003 → Newer Treatments → Anti-Tumor Necrosis Factor Therapy → Abstract #52

RESPONSE TO ETANERCEPT IN SYSTEMIC JUVENILE IDIOPATHIC ARTHRITIS (SJIA)

Y. Kimura,¹ P. Pinho,¹ G. Higgins,² D. Hummell,³ I. Szer,⁴ M. Henrickson,⁵ D. Goldsmith,⁶ C. Wallace,⁷ D. Rothman,⁸ J. Hollister,⁹ S. Li.¹

¹Pediatric Rheumatology, Childrens Hospital, Hackensack University Medical Center, Hackensack, NJ; ²Pediatric Rheumatology, Childrens Hospital, Columbus, OH; ³Pediatric Rheumatology, Vanderbilt University, Nashville, TN; ⁴Pediatric Rheumatology, Childrens Hospital of San Diego, San Diego, CA; ⁵Pediatric Rheumatology, Childrens Hospital Central California, Madera, CA; ⁶Pediatric Rheumatology, St. Christophers Hospital for Children, Philadelphia, PA; ⁷Pediatric Rheumatology, Childrens Hospital, Seattle, WA; ⁸Pediatric Rheumatology, Shriners Hospital for Children, Springfield, MA; ⁹Pediatric Rheumatology, Childrens Hospital, Denver, CO

Aim: To obtain long-term data on the safety and efficacy of etanercept in SJIA pts, and to identify factors that may predict response.
Methods: In a previous study, questionnaires were sent to pediatric rheumatologists in the U.S. regarding etanercept in SJIA pts. Data collected included demographics, medication doses, adverse reactions and disease activity measures. Those who had responded previously were sent a follow-up questionnaire. Response was assessed by % decrease in steroid dose, physician global assessment visual analog score (VAS), active joint count and acute phase reactants (APR).
Results: Complete sets of data were available for 60 pts. Mean disease duration at start of therapy was 4.9 yrs, and mean duration of therapy was 23 mos. The number of pts. on prednisone decreased from 56 to 34, mean active joint count from 12.8 to 6.2, VAS from 66 to 33 and ESR from 50 to 33 (all p0.01). Thirty-eight % of pts. had a good response (50%), while 33% had a poor response (30%). No predictive factors for response were identified. Adverse events included macrophage activation syndrome (MAS) in 2 pts. and infections in 11% (none serious). None of these directly led to discontinuation. Disease flares occurred in 15 (20.7%). Etanercept was discontinued in 21 pts, 17 for poor response. Higher doses were given to 18 (mean dose 0.8 mg/kg), and of these 12 responded. Fourteen non-responders were treated with infliximab. Data are available for 7, of whom 4 responded.
Conclusions: Most SJIA pts who initially responded to etanercept continued to do so over a mean of 23 mos, although flares were not uncommon. Some poor responders may respond to higher doses of etanercept or infliximab. No factors were identified that appeared to predict response. Aside from 2 pts. who developed MAS, there were no other serious adverse events.