Clinical remission in patients with systemic juvenile idiopathic arthritis treated with anti-tumor necrosis factor agents.

Abstract

OBJECTIVE:

To assess the frequency of clinical remission in a cohort of patients with systemic juvenile idiopathic arthritis (JIA) who received continuous anti-tumor necrosis factor (TNF) therapy; and to identify potential predictors of remission.

METHODS:

Patients with systemic JIA who were treated with anti-TNF agents for > 6 months were studied. Demographic and nosologic variables recorded at the start of anti-TNF therapy were analyzed. Association between early variables and occurrence of remission was evaluated through Cox proportional hazard regression analysis.

RESULTS:

Forty-five patients were included (30 girls), median age 9 years (range 2-17 yrs), age at disease onset 5 years (range 0.5-15), disease duration 3 years (range 0.5-13). Twenty-one (47%) children showed systemic symptoms at the start of anti-TNF therapy. Patients received therapy for 24 months (range 6-88): 45 (100%) were given etanercept, 17 (38%) infliximab, and 5 (11%) adalimumab, in combination with methotrexate. Anti-TNF switching was performed in 22 (49%) children. Eleven (24%) met definition criteria for remission while taking etanercept (n = 8), infliximab (2), or adalimumab (1). Remission occurred following 26 (range 9-65) months of therapy. Flares occurred in 5 (45%) patients 2 to 14 months after remission was first recorded. Absence of systemic symptoms at the start of therapy and fulfillment of improvement criteria at Month 3 were associated with remission in univariate analysis; no variable showed any association in multivariate analysis.

CONCLUSION:

Twenty-four percent of patients with systemic JIA experienced remission with anti-TNF therapy, but only 13% experienced sustained benefit.

• Authors: Ricardo A G Russo, María M Katsicas
• Journal: The Journal of rheumatology (J Rheumatol) Vol. 36 Issue 5 Pg. 1078-82 (May 2009) ISSN: 0315-162X [Print] Canada
• PMID: 19435972 (Publication Type: Clinical Trial, Journal Article)

Chemical References

• Antibodies, Monoclonal
• Antibodies, Monoclonal, Humanized
• Antirheumatic Agents
• Immunoglobulin G
• Receptors, Tumor Necrosis Factor
• Tumor Necrosis Factor-alpha
• Infliximab
• Adalimumab
• Etanercept
• Methotrexate

Topics

• Adalimumab
• Antibodies, Monoclonal (therapeutic use)
• Antibodies, Monoclonal, Humanized
• Antirheumatic Agents (therapeutic use)
• Arthritis, Juvenile (drug therapy, physiopathology)
• Child
• Child, Preschool
• Drug Therapy, Combination
• Etanercept
• Female
• Humans
• Immunoglobulin G (therapeutic use)
• Infant
• Infliximab
• Male
• Methotrexate (therapeutic use)
• Receptors, Tumor Necrosis Factor (therapeutic use)
• Remission Induction
• Tumor Necrosis Factor-alpha (antagonists & inhibitors)