Background Juvenile idiopathic arthritis is a quite widespread pathology in the group of connective tissue diseases and leads to severe disability in case of inefficient treatment. With the extension of medical drug offer, it became possible to bring a patient into remission, to prevent the joint destruction and organ involvement. Still the selection of basic drug for particular child remains a difficult task, as well as the selection of the biologics, usually TNF-a blocker, in case of failure. There are different approaches in this case: to take another TNF-a blocker or the medicine with different work principle, for example, Abatacept.
Methods Experience of Abatacept application in the centre counts about 2 years. The retrospective analysis of efficiency, reasons of the cancellation and undesirable side effects was held.
Results Total number of children who received Abatacept was 20 patients. 17 of them were females and 3 – males. Length of disease before Abatacept prescription was 6,2 years on average. Average age of children was 11 years (from 4 to 15 years). Dose corresponded with standard: 10 mg/kg according to scheme 1-15-29 days and then each 28th day by intravenous diffusion. All children had active arthritis: polyarthritis, RF – 11 children, oligoarthritis + uveitis – 4 children, systemic JIA without systemic signes – 5 children, oligoarthritis – 1 child. The average length of application was 8 months (from 3 to 20 months). It is interesting to mention that for 17 of 20 children Abatacept was the first biologic after failure of standard basic therapy that included application of glucocorticoids at 12 of 20 children (60%). One basic medicine was inefficient at 3 of 20 children, two were uneffective at 9 of 20 children, three – at 7 of 20 and four were inefficient at 1 person. It is easily seen that the arthritis was very active, because most part of children received 2 or 3 basic medicines, while the observation period for efficiency assessment was more than 3 months. 78% of patients achieved ACR Pedi 30, that corresponds with published research data. The maximal effect is connected with VAS of pain which is the most sensitive and dynamic measure. Positive dynamics also were seen by SRP and ESR that reflect the inflammation activity. Abatacept was cancelled at 7 of 20 patients (35%), while 65% continue receiving the treatment. Reasons for cancellation were remaining exacerbation of uveitis, activity of joint syndrome, diffusion of arthritis. For one child Orencia was cancelled because of an impossible venous access. The medicine was cancelled: in case of oligoarthritis at 2 children (60%), systemic arthritis at 1 person (20%), seronegative polyarthritis at 3 person (27%).
Undesirable side effects are: severe headache and stomachache, that appeared at 1 patient on 7th day after Orencia infusion (she received 3 infusion in general).
Conclusions Efficiency of Abatacept can be compared to the other biologics by ACR Pedi criteria.
A good safety profile: low frequency of undesirable side-effects, low frequency of severe undesirable side-effects and infusion reactions.
No cases of tuberculosis, opportunistic infections, pneumonia were registered.
Disclosure of Interest None Declared
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