Background The efficacy and safety of etanercept (ETN) has been demonstrated in patients with juvenile idiopathic arthritis (JIA) from 4 years, although more data are needed regarding the population under 4 years old.
Objectives The aim is to evaluate the efficacy and safety of etanercept in patients under 4 years old diagnosed with polyarticular JIA and to assess the adherence to drug treatment in this population.
Methods We analyzed retrospectively, from medical records of patients, the following variables: epidemiologic data, number of active and limited joints at baseline and at 6 months; we also registered laboratory parameters including CRP, ESR, iron and hemoglobin. Other variables recorded were CHAQ punctuation; physician and parents global assessment at baseline and 6 months of treatment. Continuous variables are presented as means±SD.
Results From a total of 25 patients with JIA younger than 4 years old treated with ETN only 21 were analyzed. There were 14 girls and 7 boys with a mean age at diagnosis of 23±19.4 months. All patients had received methotrexate (MTX), corticosteroids (prednisolone) and ETN (0.8mg/kg/wk) as initial therapy. The mean duration of treatment with etanercept was 36.6±22 months.Iron laboratory values at baseline were low (49.89±25.6μg/dl) but normalized at 6 months of treatment (70.76±31.2μg/dl). Number of active and limited joints at baseline were 12±4.3/3.5±5.1 respectively; at six months of treatment were 1.44±1.77/1±1.33.CHAQ punctuation at baseline was 1.2±0.3 and 0.4±0.2 at six months. Physician and parents’global assessment at baseline were 71.5±11.5/70±14.1 respectively and 11.6±11.2/12.9±12.4 at 6 months of treatment. CRP and ESR parameters at baseline were 40.8±24.1 mg/l/51.9±19.4 mm/h respectively and 3±4.9 mg/l/14.1±8.3mm/h at six months of treatment. All patients achieved clinical remission at 6 months of treatment. Furthermore, in all patients discontinuation of therapy with corticosteroids was performed and 60% achieved discontinuation of MTX after 6 months of treatment. ETN was discontinued in 2 patients (9.5%) due to remission of the disease: one outbreak must be restarted on therapy after 3 months and the other remains in remission without treatment a year later. Four patients (19%) remained at doses below 0.8mg/kg/wk. Any patient had serious adverse effects secondary to treatment.
Conclusions Although important joint involvement and alteration of analytical parameters at baseline a high percentage of patients achieved remission at 6 months of treatment with etanercept. All patients could reduce concomitant medication and dose reduction or withdrawal of etanercept was possible in some patients. Treatment with etanerceptin patients under 4 years old is shown as safe and effective in our patient group after 6 months of treatment.
Disclosure of Interest None Declared