TY - JOUR
T1 - Tumor Necrosis Factor-blocking Agents for Children with Enthesitis-related Arthritis - Data from the Dutch Arthritis and Biologicals in Children Register, 1999-2010
AU - Otten, M.
AU - Prince, F.H.
AU - Twilt, M.
AU - ten Cate, R.
AU - Armbrust, W.
AU - Hoppenreijs, E.P.A.H.
AU - Koopman-Keemink, Y.
AU - Wulffraat, N.M.
AU - Gorter, S.L.
AU - Dolman, K.M.
AU - Swart, J.F.
AU - van den Berg, J.
AU - van Rossum, M.A.
AU - Suijlekom-Smit, L.W.A.
PY - 2011/10
Y1 - 2011/10
N2 - 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 (I 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.Conclusion. 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. (First Release Aug 15 2011; J Rheumatol 2011;38:2258-63; doi:10.3899/jrheum.110145)
AB - 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 (I 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.Conclusion. 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. (First Release Aug 15 2011; J Rheumatol 2011;38:2258-63; doi:10.3899/jrheum.110145)
KW - JUVENILE IDIOPATHIC ARTHRITIS
KW - ENTHESITIS-RELATED ARTHRITIS
KW - ANTI-TUMOR NECROSIS FACTOR
KW - BIOLOGIC THERAPY
KW - RESPONSE
KW - PLACEBO-CONTROLLED TRIAL
KW - TERM-FOLLOW-UP
KW - ANKYLOSING-SPONDYLITIS
KW - RHEUMATOID-ARTHRITIS
KW - ETANERCEPT
KW - EFFICACY
KW - SAFETY
KW - SPONDYLOARTHRITIDES
KW - METHOTREXATE
U2 - 10.3899/jrheum.110145
DO - 10.3899/jrheum.110145
M3 - Article
C2 - 21844151
SN - 0315-162X
VL - 38
SP - 2258
EP - 2263
JO - Journal of Rheumatology
JF - Journal of Rheumatology
IS - 10
ER -