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The use of Etanercept and Adalimumab in the management of JIA: a 5-year follow-up study

Aim

To evaluate the 5-yr use of 2 anti-TNF preparations, Etanercept (ET) and Adalimumab (AD), in children with refractory to conventional treament JIA.

Patients-methods

The safety and efficacy of ET and AD were assessed in 46 children aged 2–16 yrs. 32/46 received ET and 14 AD together with a DMARD (45/46), mainly methotrexate, and prednisone (22/46). All pts were assessed clinicaly, cardiologicaly, hematologicaly, biochemicaly and immunologicaly pre- and every 3–6 mo port-treatment. Efficacy was assessed by the application of ACRped criteria.

Results

Safety: Common respiratory tract infections were recorded in 28% of pts (10/34 under ET and 3/14 under AD). Serious infections were recorded in 4.7% (1 ET, 1 AD). No other serious adverse effects were recorded. Efficacy: ACRped 50–70. 1 st yr: 88% of the ET and 68% of the AD group. 2 nd yr: 81% of the ET and 66.7% of the AD group. 3 yr: 83% of the ET and 100% of the AD group. During the 5-yr period, 11/46 pts (28%) switched from ET to AD or vice versa. Of all patients, 32.5% discontinued anti-TNF treatment due to remission and 52.2% had a satisfactory response (ACRped 50–70), while 8.7% had a poor response either to ET or AD.

Conclusion

Most of the patients with refractory to conventional treatment JIA respond satisfactorily to the long-term administration of anti-TNFs. The first 2 years are critical to predict a good and sustained response. Although serious infections are rare, a systematic vigilance is warranted in order to avoid fatal outcomes.

Author information

Correspondence to M Trachana.

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Open Access This article is published under license to BioMed Central Ltd. This is an Open Access article is distributed under the terms of the Creative Commons Attribution 2.0 International License (https://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Keywords

  • Adverse Effect
  • Methotrexate
  • Tract Infection
  • Respiratory Tract
  • Prednisone