Abstract
Treatment of juvenile idiopathic arthritis (JIA) is one of the most complex and urgent problems of rheumatology. Objective : We undertook a study to evaluate the effectiveness and safety of long-term therapy with etanercept in patients with JIA without systemic manifestations. Methods and patients : Patients in the study were divided into 2 groups. Patients of the main group (n = 197) received etanercept, the comparison group (n = 200) - methotrexate. The effectiveness was assessed by the American College of Rheumatology (ACR) criteria and Wallace's criteria for clinical remission (CR) and the 4-year JADAS71 index. Results : We included 397 patients with JIA. In 6 months and 12 months a remission of articular syndrome was detected in 72 and 53 patients respectively; 83% and 65% of patients receiving etanercert and methotrexate, respectively. Laboratory indicators of disease activity corresponded with reference values in 91 and 48% in a period of 6 months, in 12 months - in 94 and 68% of patients. According to the results of Childhood Health Assessment Questionnaire (CHAQ ) functional activity fully recovered in 65 and 79%; 30 and 58% of children in a period of 6 and 12 months of follow-up. Within 1 month improvement according to ACR pedi criteria 30/50/70 was achieved in 79/62/34% of patients treated by genetically engineered biological agents. After 6 months AKRpedi criteria 30/50/70 was achieved in 97/96/89% and 63/57/47% against the background of therapy with etanercept and methotrexate, respectively. Etanercept induced inactive stage of the disease / remission [6 (4, 9) and 12 (6, 18) months; p <0,0001, respectively] in significantly shorter time than methotrexate. Within 6 and 12 months of follow up inactive stage of the disease / remission was reported in 30 and 49% of patients treated with inhibitor etanercept, and 9 and 38% of patients receiving methotrexate. Disease activity index JADAS71 in children treated with etanercept was significantly lower than in patients treated with methotrexate for 1 year. Conclusion : Etanercept has a significantly faster and more pronounced anti-inflammatory effect than the classic immunosuppressant methotrexate.
Highlights
Treatment of juvenile idiopathic arthritis (JIA) is one of the most complex and urgent problems of rheumatology
The effectiveness was assessed by the American College of Rheumatology (ACR) criteria and Wallace's criteria for clinical remission (CR) and the 4-year JADAS71 index
Within 1 month improvement according to ACRpedi criteria 30/50/70 was achieved in 79/62/34% of patients treated by genetically engineered biological agents
Summary
Цель исследования: оценить эффективность и безопасность длительной терапии этанерцептом у пациентов с ЮИА без системных проявлений. Через 6 и 12 мес ремиссия суставного синдрома зарегистрирована у 72 и 53 (83 и 65%) пациентов, получавших этанерцерт и метотрексат, соответственно. Спустя 6 мес показатель АКРпеди30/50/70 составил 97/96/89% и 63/57/47% в условиях терапии этанерцептом и метотрексатом, соответственно. Этанерцепт в достоверно более короткие сроки, чем метотрексат, индуцировал стадию неактивной болезни/ремиссию [6 (4; 9) и 12 (6; 18) мес; p < 0,0001, соответственно]. Через 6 и 12 мес наблюдения стадия неактивной болезни/ремиссия была зарегистрирована у 30 и 49% больных, лечившихся ингибитором этанерцептом, и у 9 и 38% пациентов, получавших метотрексат. Активность болезни по индексу JADAS71 у детей, лечившихся этенрцептом, была значимо ниже, чем у больных, получавших метотрексат, в течение 1 года.
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