Background Biological agents have demonstrated a favourable benefit-to-risk profile. Nevertheless, intolerance, lost of efficacy or adverse events has led to try other therapeutic options as the use of new TNF-inibithors. Since november ’99 to dicembre 2011, 288 patients affected by refractory JIA were treated with TNF inhibitors.
Objectives To evaluate in a single pilot study efficacy and safety of Certolizumab in JIA with active polyartritis, non responders to MTX, antiTNF, anti CD20 and anti-IL-1.
Methods During the last 8 months we have switched to Certolizumab 12 young adults (8 F, 4 M) non responders to the older biological agents. Two patients had a Systemic onset of JIA, 3 polyarthritis RF negative, 2 oligoarthritis persistent and 5 oligoarthritis extended. Median age 23.5 yrs, median onset age 7.7 yrs, median disease duration 17.7 yrs. All patients had active disease; three of them had active uveitis as well. Patients received Certolizumab at the dose of 400 mg s.c. at week 0, 2, 4 and 200 mg every other week, as in RA. All patients had failed more previous DMARDS (as MTX, Ciclosporin, Chlorambucil, gold therapy), and TNF inhibitors (Infliximab, Etanercept, Adalimumab), Rituximab and Anakinra.
Results All patients were evaluated according to EULAR criteria (DAS 28). No serious adverse events were observed. Eight patients (66.6%) were responders, 4 patients (33.3%) were non responders (3 of them =25% droped-out). Two patients out of 3 with chronic active uveitis showed a visus improvement.
Conclusions Certolizumab could be another new treatment of long lasting refractory JIA (including cases complicated by uveitis), in young adults non responders to the previous generation of antiTNF. In our knowledge, this is one of the first experiences in the use of Certolizumab in young adults affected by JIA.
Disclosure of Interest None Declared