Background The treatment paradigm for Juvenile Idiopathic Arthritis (JIA) has changed in last decade:Early diagnosis,objective assessment & appropriate use of biologic response modifiers (BRMs) are common place.Etanercept (Et) is available in India for 15yrs. BRM use in developing world is fraught with challenges: cost, high burden of Tuberculosis (TB) & retention. In view of the cost & safety concerns regarding TB, at our centre, full dose Et is used for 3–6 mths, followed by dose tapering as tolerated.
Objectives 1. To determine the use, safety & efficacy of Et in JIA. 2. To determine the factors that determine responders vs non responders. 3. To determine the factors that determine disease free survival on stopping Et
Methods This study was done from 15thJune'15 to15thDec'16 (18mths) at Sir GangaRam Hospital. Inclusion criteria: All JIA pts who took Et for min 12 wks & attended the outpatients during the study period. Outcome: All pts who achieved the Wallace criteria of inactive ds, clinical remission on (CRoM) or off medication within 4 months were termed as responders.
Results Use: 46pts recd Et (29M,17F). Median (Md) age at JIA onset: 9.08yrs (1.16–16.5).Md delay to diagnosis: 4mths (0.5–63). Md age at initiation of Et: 11.6yrs (4.25–20.3). Indications: Partial response to Intraarticular steroids/bridging steroids & DMARD-32; Started upfront for high ds.burden: 14. Diagnoses: ERA30 (65%), Poly JIA8 (17%), OJIA 3 (7%), SOJIA 3 (7%) & UJIA 2 (4%). Safety: Screening: Mantoux +ve: 6, Quantiferon+ve: 2,antitubercular therapy for latent TB: 8. Side effects: 41 (88%) had no adverse event. 5 pts - 1 each had enteric fever, varicella, uveitis, hemolysis, malaria. Follow up: Md duration of follow up-47.5 mths (2–147). Medications at last follow up: Et ongoing in 20 (43.5%), 12 on 2nd BRM, 12 off BRM & 2 lost to follow up. Status at last follow up: Of 37 responders - 8 currently active.
Responders vs non responders: 37 responded (2 excluded duration <12 wks). In all responders drug was tapered/stopped. No demographic, clinical, lab criteria could predict responder from non responder (Table 1).
Of 37 responders, 15 (40.5%) did not show any flare (Table 2).
Disease free survival on Et: Of 37 responders, 22 flared. No factors could predict flare in pts who recd tapering Et dose or after stopping Et. Some needed repeat cycles of Et/2nd BRM. Kaplan Meier curve of responders confirmed that no pt would be flare free at 63mths of follow up.
Conclusions Et is safe to use & had no adverse events in 89%. Needed most for ERA. Effective in 84%. On using shortterm Et, 59% flared either on tapering/stopping. These pts responded to reinitiation of Et/BRM. On long term follow up (63mth) there were no flare free pts.
Disclosure of Interest None declared
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