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Etanercept May Not Be Best Option For Juvenile Idiopathic Arthritis
A DGReview of :"Efficacy of etanercept for the treatment of juvenile idiopathic arthritis according to the onset type"
Arthritis & Rheumatism
04/17/2003
By Veronica Rose
Patients with juvenile idiopathic arthritis who are treated with etanercept may experience an initial positive response but often fail to maintain improvement, and they may experience a wide variety of severe side effects.
Researchers suggest that alternative therapeutic management may be necessary for patients with systemic-onset JIA who experience a higher rate of treatment failure. This recommendation follows the completion of a study, led by Dr. Pierre Quartier of Unité d'Immuno-Hématologie et Rhumatologie pédiatrique, Hôpital Necker-Enfants Malades, in Paris, of the efficacy and tolerance of etanercept among this patient group.
Sixty one JIA patients with active chronic polyarthritis participated in the 13-month, open-label, multi-centre, prospective study. The children were enrolled between November 1999 and June 2001. All had experienced a poor response or intolerance to methotrexate.
The researchers sent a questionnaire to the treating physicians. The validated international core-set score for JIA activity were then assessed every three months, and the researchers undertook an intent-to -treat analysis. In addition, treatment failure risk was compared in patients with systemic-onset, oligoarticular-onset or polyarticular-onset JIA.
One patient was unable to continue in the study due to pregnancy. Twelve other patients experienced severe side effects which included neurologic or psychiatric disorders, ranging from retrobulbar optic neuropathy, major weight gain, severe infection, cutaneous vasculitis with systemic symptoms, haemorrhagic diarrhoea, uveitis flare and pancytopaenia. All these side -effects disappeared once treatment with etanercept was discontinued although one child was subsequently diagnosed with Crohn's disease.
There was an initially improvement in scores in 73 % of patients after three months, but this fell to 39% after 12 months. The researchers also rated the response among those with systemic-onset JIA as significantly lower than those with the oligoarticular or polyarticular onset form of the disease.
Arthritis & Rheumatism 2003;48:4:1093-1101.
"Efficacy of etanercept for the treatment of juvenile idiopathic arthritis according to the onset type"
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